A focus on best practice

Six Satellite Symposia took place

Early assessment and treatment, and functional recovery are key focal points

• Four concentrated on schizophrenia with one highlighting how functional recovery is a key goal that can be aided by addressing treatment adherence;¹ another focusing on optimal management regarding treatment choice and timing;² the third discussing how early onset schizophrenia necessitates swift diagnosis and treatment³ that balances functional recovery and potential adverse events from pharmacological treatment;⁴ and the last highlighted unmet needs in pharmacotherapy and how novel receptor treatment targets may meet these⁵
• One symposia focused on the need for earlier diagnosis of Alzheimer’s disease and how psychiatric phenomena may be overlooked in such patients
• The sixth discussed ‘hot topics’ in major depressive disorder (MDD) including the impact of COVID-19;⁶ emotional blunting due to depression and/or treatment;⁷ and the use of antidepressants for MDD in patients with trauma⁸

Impacts of the COVID-19 pandemic

Undoubtedly, the COVID-19 pandemic has changed healthcare and clinical trial practices and two ‘Innovative Format’ sessions focused on this.

Digital medicine has been transformed very much during the COVID-19 pandemic

• The ‘New Frontiers Session’ looked at how digital health is, or can, change how clinical trials are run and how digital therapeutics can be used for brain disorders. Pharmaceutical industry and regulatory representatives discussed the impact and implications of digital technology on future drug development and clinical trials.
• The ‘Patient Session’ brought together a patient representative to talk about their experiences of coping with a psychiatric illness during lockdown and a clinician to cover the practice side.

Expanding our understanding of psychiatric conditions

Four symposia explored some key factors in neurobiology:

• Hyper-aggression may be a common, but poorly controlled, feature in many neuropsychiatric disorders. Neuropathological studies illuminate the basic brain framework that drives aggression and how this may be controlled pharmacologically⁹
• While there are known sex differences in brain disorders,¹⁰ many studies have neglected to include females or analyze sex as a biological variable, impacting treatment choice and success
• The gut-brain axis is rapidly becoming a focus in psychiatry and one symposium explored orexigenic stimuli (from food or digestive system cues) of appetite and hunger;¹¹ the effects of nutrients on cognition and stress resilience; and neuronal circuits involved in feeding decisions
• More work is being done on how immuno-inflammatory abnormalities may lead to or exacerbate psychiatric disorders¹² and the importance of identifying and characterizing patients with pro-inflammatory conditions was highlighted

Key topics include addressing hyper-aggression; understanding how neurological sex differences can affect treatment; the importance of the gut-brain axis; and identifying immune-inflammatory abnormalities

The Keynote Session, by Professor Ray Dolan, discussed how the hippocampus and related structures, as well as the ventro-medial prefrontal cortex, are involved in building and updating our mental models of the world and the importance of neural replay in the expression of psychopathology.

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