ABSTRACTS - World Psychiatric Association

as a structural imbalance between hospital-based and outpatient care.
Available resources are decreasing as the demand is rising (+74% of
adult patients treated in the public sector over the last 15 years). The
creation of facilities and teams not well integrated in the mental
health care system, and the enduring gaps between health care, social
care, the educational and juridical systems, are often translated in
poor coordination and difficult integration between different roles
and functions. Based on this critical evaluation of mental health care
in France, in 2005 the government has set up a psychiatric and mental
health care plan covering the period 2005-2008. This aims at
improving the coordination and integration between different sectors
of health and social care; to promote the involvement of patients,
families and professionals in decision-making and to launch antistigma
programmes; to improve the quality of care and research activities;
and to tackle specific disorders or problems presented by specific
population groups through the implementation of targeted programmes.
However, criticisms about the real functioning of this plan
have been expressed by different stakeholders.
RS13.3.
DEVELOPMENTS IN ENGLISH MENTAL HEALTH
CARE: 1988 TO 2008
G. Glover
University of Durham, UK
Mental health care services in England have developed considerably
in the last 20 years. During the late 1980s and early 1990s, the priority
was to develop adequate coordination for the non-institutional
care approaches for people with severe mental illnesses, which were,
by then, becoming the normal approach. Following a major government
review in 1998, the focus has been on developing uniform
access to home-based care teams for acute mental health crises, early
intervention services for psychosis and assertive outreach teams for
people with chronic illness at risk of frequent relapse. Since 2000, a
number of detailed data sources have been set up documenting their
structure and activity. An annual service mapping exercise has been
carried out, covering services for mentally ill adults of working-age
each year since 2000, and children and adolescents since 2002. A
dataset documenting the content and timing of mental health care for
working-age and older adults has been in place since April 2003. This
paper outlines the principles underlying the developments, attempts
to quantify the extent of the changes overall, and touches briefly on
the issue of how consistent the changes have been in different parts of
England.
RS13.4.
MENTAL HEALTH CARE IN GERMANY: CURRENT
STATE AND TRENDS
H.J. Salize, W. Rössler, T. Becker
Central Institute of Mental Health, Mannheim, Germany;
Psychiatric University Hospital, Zurich, Switzerland; Psychiatric
University Hospital, Ulm, Germany
Germany turned towards community-based mental health care in the
mid seventies, within a general climate of social and political reform.
The continuing deinstitutionalisation process and the implementation
of community mental health services was considerably affected
by the reunification of East and West Germany in 1990, which
required dramatic changes in the structure and quality of the mental
health care system of the former German Democratic Republic. Overall,
German mental health care is organised as a subsidiary system,
where planning and regulating mental health care is the responsibility
of the 16 federal states. So, German mental health care provision is
spread among many sectors and characterised by considerable
regional differences. A key characteristic is the particularly wide gap
between inpatient and outpatient services, which are funded separately
and staffed by different teams. However, the momentum of the
psychiatric reform has been strong enough to assimilate the completely
different mental health care system of the former German
Democratic Republic and, in the course of a decade, to re-structure
mental health services for an additional 17-18 million new inhabitants.
In an ongoing struggle to adapt to changing administrative setups,
legal frameworks, and financial constraints, psychiatry in Germany
is currently facing specific problems and is seriously challenged
to defend the considerable achievements of the past. A major obstacle
to achieving this aim lies in the fragmented system of mental
health care provision and mental health care funding.
RS14.
OBSESSIVE-COMPULSIVE DISORDERS:
TRANSLATIONAL APPROACHES
AND NEW THERAPEUTIC STRATEGIES
RS14.1.
BEHAVIORAL ADDICTION, IMPULSIVITY
AND OBSESSIVE-COMPULSIVE DISORDER
S. Pallanti, S. Bernardi
Department of Psychiatry, University of Florence, Italy;
Department of Psychiatry, Mount Sinai School of Medicine, New
York, NY, USA
As part of the research planning agenda for the DSM-V concerning
obsessive-compulsive-related disorders, experts from academic medical
centers around the world suggest the creation of a new diagnostic
category that includes behavioral and substance addictions.
Chemical and behavioral addictions, characterized by impulsive
choice, reward sensitivity, and involvement of fronto-striatal brain
circuitry, with frontal lobe deficits, are conceptualized are as parallel
category to obsessive-compulsive disorder (OCD) spectrum. Craving
and impulsivity, in fact, are complex phenomena that involve different
brain circuitries and neurobiological factors. Both are present in
different psychiatric disorders, with different clinical presentations
and phenomenologies. One of those forms would be an obsessivelike
craving, where craving is experienced as an intrusive thought
resulting in impaired control. This obsessive-compulsive subtype of
craving might be correlated, similarly to OCD, to serotonin dysfunction.
According to this model, the most fully documented neurobiological
findings regarding impulse control disorder involve serotonin.
Evidence for the involvement of serotonin in pathological gambling
comes from challenge study results, such as an increased prolactin
response to the serotonergic agonists m-CPP and sumatriptan. Challenge
studies analysing growth hormone response to clonidine pointed
out also a different noradrenergic role in pathological gambling.
An involvement of the prefrontal cortex and an action of lithium on
this brain area is hypothesized on the basis of functional neuroimaging
data.
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