Objective: A potential influence of infections and immunological aspects on etiology and pathogenesis of bipolar disorders has been discussed. Our aim was to detect an intrathecal specific antibody synthesis against neurotropic agents that have been linked to bipolar disorders. Methods: We evaluated the concentration of antibodies against 4 neurotropic agents (Herpes simplex virus type 1/2, Epstein-Barr virus, Cytomegalovirus, Toxoplasma gondii) in paired cerebrospinal fluid and serum samples from 40 patients with bipolar disorders using an enzyme-linked immunosorbent assay. The specific antibody index (AI) was calculated and an AI> 1.4 was considered as evidence of intrathecal specific antibody synthesis. 26 patients with Pseudotumor cerebri served as controls. Results: 8 of the 40 patients with bipolar disorders had a specific intrathecal antibody synthesis against at least one of the 4 neurotropic agents compared to 1 patient in the control group. Concerning these 8 patients, there was no significant preponderance of a single neurotropic agent. Conclusions: Our results disagree with theories that discuss a direct role of HSV, CMV, EBV and T. gondii in etiology of bipolar disorders. However, the trend for polyspecifc intrathecal antibody synthesis may indicate an activation of the intrathecal humoral immune system in patients with bipolar disorders as it is known for, e.g. multiple sclerosis.

There are some doubts as to whether psychotherapy will remain in the armamentarium of future psychiatrists. Few studies have explored early career psychiatrists’ views and their experience with psychotherapy training. The Early Career Psychiatrists’ Council of the WPA carried out an online survey on training and practice in psychotherapy in 13 European countries in order to assess: main characteristics of psychotherapy training in the partecipating countries; organizational and clinical differences of psychotherapy training; trainees’ satisfaction and confidence in the use of psychotherapy. An online survey was conducted through the use of a questionnaire specifically developed for the purposes of this study.Responders were required to collect their opinions on the basis of their own experience. Different aspects of psychotherapy training, such as compulsoriness, payment and supervision, as well as satisfaction with received training and confidence in the use of psychotherapy have been investigated. Results show that training in psychotherapy is mandatory in all countries, except Belgium and France, but most of early career psychiatrists have to pay for it. European trainees are satisfied (70%) with received training, and feel confident to treat patients in psychotherapy settings. Psychodynamic and cognitive-behavioural techniques are more common than systemic, interpersonal, supportive and psychoeducational ones. In 3 countries out of 12 it is not compulsory to attend a psychotherapy training, and only psychodynamic and cognitive-behavioural approaches are widely spread in all countries.This survey is a starting point to improve training and practice of psychotherapy across Europe and to enhance early career psychiatrists’ psychotherapeutic skills and knowledge.

Objectives Guidelines produced for management of Bipolar Disorder illustrate change in evidence-base for treatment of acute and maintenance phases of illness. Our Pan-European Research Group assessed clinical practice and desired treatments amongst amongst Psychiatry trainees. Methods A semi-structured survey was piloted, and homogenous sample size (at least 50) agreed upon from each country, with 50% minimum response rate. It was distributed via web-link, questioning preference of mood stabiliser for patients, trainees themselves and factors influencing choice. Results Tables 1 summarise choices. Number (n) Percentage Drug(s) 263/224 40.8/34.8 Lithium 121/101 18.8/15.7 Semisodium Valproate 133/85 20.7/13.2 Sodium Valproate 21/50 3.3/7.8 Lamotrigine 27/18 4.2/2.8 Lithium and Sodium Valproate 10/15 1.6/2.3 Carbamezapine 24/12 3.7/1.9 2nd Generation Atypical antipsychotics 8/4 1.2/0.7 Various combinations 34/134 5.3/21 Left blank [Choice of mood stabiliser for patient/themselves] Factors influencing decision-making mapped onto cost, efficacy and side-effect profile (less than 4% other reasons). 66% (n=538) of respondents felt efficacy most important, 25% (n=202) felt side-effect profile most important and 3% (n=24) considered cost of most importance. Conclusions No clear difference exists in choice of mood stabiliser for European trainees and their patients, and decisions based on perceived efficacy are generally in keeping with established guidelines.

ObjectivesRecent evidence has questioned modern psychiatric clinical practice, specifically the prescribing of “atypical” antipsychotics. Our Pan-European Research Group wished to ascertain clinical practice amongst European trainees, which treatments trainees would desire for themselves, and factors influencing this.MethodsA semi-structured survey was constructed from prior literature, piloted, and a homogenous sample size of at least 50 was agreed upon from each country, with 50% minimum response rate. It was distributed via web-link, with questions on preference of antipsychotic for patients in given scenarios, and factors influencing choice. Physicians were asked for their preference should they develop psychosis.Resultsi)Treatment choice of antipsychotic for patients93% (n=600) of respondents chose to prescribe “atypical” antipsychotics (excluding Clozapine), 6% (n=42) choosing “typical” antipsychotics, 1% (n=6) choosing Clozapine as first-line therapy.ii)Treatment choice if trainees developed psychosis89% (n=530) of responders chose to prescribe “atypical” antipsychotics (excluding Clozapine), 7% (n=40) choosing “typical” antipsychotics, 4% (n=23) choosing Clozapine as first-line therapy.iii)Factors influencing choiceThese mapped onto three domains: cost, efficacy and side-effect profile (less than 5% other reasons). 79% (n=458) of those who responded felt efficacy most important, 46% (n=270) felt side-effect profile most important and 3% (n=16) considered cost of paramount importance.38% (n=272) of those who responded to the survey stated that the CATIE trial had influenced their decision-making.ConclusionsPsychiatry trainees’ choice of antipsychotic medication for both patients and themselves is based on perceived benefits, as opposed to evidence base and recent literature.

There is no doubt that, in the modern era, psychiatry and the pharmaceutical industry have a relationship, though the nature of this is not universally well defined. Given that psychotropic medication is widely prescribed (ranking 3rd and 4th in US sales in 2007), and the role of the pharmaceutical industry in medical education has come under scrutiny, it is worth noting that the relationship between the industry and psychiatry trainees has not been studied in great depth.Our Pan-European research group, composed exclusively of psychiatry trainees from at least 18 different countries, as part of the European Federation of Psychiatric Trainees (EFPT) has sought to study this in a systematic fashion. I will present preliminary findings of our survey, PRIRS (Psychiatric Residents-Industry Relationship Survey) which is currently taking place.It is also hoped that this will facilitate a discussion amongst those attending the session, on the role of the pharmaceutical industry in psychiatric training, education and in general.

SummaryA Pan-European group of psychiatric trainees conducted a semi-structured web-based survey of factors influencing decision-making in relation to antipsychotic, antidepressant and mood stabilizer prescribing. The acceptance of such a survey is in itself a positive result. In the current climate of evidence based medicine and guidelines, preliminary results from this survey suggest that, when asked regarding treatment choice for themselves, psychiatry trainees preferred second-generation atypical antipsychotic medication, based on perceived efficacy. The results for mood stabilisers were less striking. The relevance of this survey, in the context of recent evidence, may relate to trainees’ perceptions as opposed to evidence base.

Treatment choice in psychiatry? Would trainees choose similar treatments to those prescribed, and what influences decision-making? A survey of the European Federation of Trainees' (EFPT) Research Group - Volume 21 Issue S2