Eighth Kraepelin Symposium—Translation in Psychiatry and Psychotherapy: A Life-Long Necessity

In the 19th century, Emil Kraepelin¹ founded the hospital, today known as the Department of Psychiatry and Psychotherapy of the University of Munich. A symposium in his memory takes place annually led by Peter Falkai and Annette Schaub. The overall idea for this symposium was based on a symposium in honor of Mike Goldstein,² showing the importance of drug and family therapy in the aftercare of acute schizophrenia. The speakers and their topics are described in the order of their appearance.

The 2020 symposium was influenced by the current worldwide pandemic situation. In 1890, Kraepelin also managed an influenza pandemic of his times³ and had remarked that postinfluenzal psychoses provided impetus to the investigation of exogenous factors in the etiology of psychoses in general, one of the most vigorously debated topics in neurology and psychiatry until the Second World War.⁴ Therefore, Peter Falkai and his group started off presenting data of the current pandemic, including prognostic data of machine learning.^3,5,6 A multidisciplinary team of psychiatric, psychological, spiritual care, psycho-oncological, and palliative care specialists developed a new psychosocial first aid model for inpatients, their family members, and hospital staff. It consisted of five elements: hotline for patients and coworkers, psychosocial support for patients and relatives using tablets, and psychosocial consulting service. The results of machine learning covered watchful waiting, self-management (SM), SM + 4 online intervention, and augmented online-psychotherapy.

Andreas Meyer-Lindenberg showed neural correlates of individual differences in affective benefit of real-life urban green space exposure.⁷ Higher green-related affective benefit was related to lower prefrontal activity during negative-emotion processing, which suggests that urban green space exposure may compensate for reduced neural regulatory capacity. Elisabeth Binder presented translational neurogenetics of psychiatric disorders covering the development of novel treatment strategies in schizophrenia, based on multimodal neuroimaging, genetic, and stressful life events.⁸ Thomas Ehring showed that trauma may lead to severe physical and psychiatric disorders stressing the transition from psychological targets in trauma to psychotherapy.⁹ Pat McGorry did set up the early invention paradigm that had a positive impact for the health system in the United Kingdom^10,11 and reduced its costs. He developed an approach for young people who have symptoms of psychosis for the first time offering a service for young people with subthreshold symptoms who are at risk of developing psychosis. He has generated a body of research to determine the correct sequence of treatment, including psychosocial interventions.

Ilona Kambeitz reported on studies about cognition and relapse prevention in schizophrenia, which showed that patients trained with cognitive remediation (CR) in a computerized version combined with human coaching did better than those in on a computerized version.¹² Philippa Garety and her group¹³ showed AVATAR, an approach in which people who hear voices have a dialogue with a digital representation of the presumed persecutor to be more effective after 12 weeks of treatment than supportive counseling in reducing the severity of auditory verbal hallucinations. Brandon Gaudiano proved the feasibility of Acceptance and Commitment Therapy for patients with schizophrenia (ACT-IN) in a routine clinical setting and started a larger effectiveness study.¹⁴

In the lab of Nikolaos Koutsouleris, multivariate and neuroanatomic patterns were analyzed to prevent the full-blown manifestation of schizophrenia using clinical interventions, and there was a differentiated analysis of clinical outcome in high-risk patients for schizophrenia and recent onset depression.¹⁵ The level of psychosocial functioning was added in this model after discussing it with experts.^16,17 William Carpenter focused on the clinical high-risk controversies and challenges for experts. The key is understanding the implications of the diagnosis and the need for a further clinical characterization in order to personalize management. Kim Mueser^18,19 gave an overview of psychological treatment in first episodes with schizophrenia focusing on NAVIGATE. This is a team-based, multicomponent treatment program designed to be implemented in routine mental health treatment settings and aimed at guiding people with a first episode of psychosis (and their families) toward psychological and functional health. The core services include the family education program, individual resiliency training, supported employment and education, and individualized medication treatment. It embraces a shared decision-making approach with a focus on strengths and resiliency and on collaboration with clients and family members in treatment planning and reviews aimed to fill an important gap in the US healthcare system.

Stephan Leucht²⁰ focused on the evidence of the guideline in long-term treatment and showed a living systematic review on the consequences of the COVID-19 pandemic and the degree of containment measure in the various countries (“Mental Health Covid”). Two projects apply the novel concept of “crowd sourcing,” ie, approximately 60 volunteers experienced in meta-analysis will do the study selection and data extraction on a webpage or the German National S3 Schizophrenia Guideline will be converted into a living format (“SISYPHOS”). Irene Bighelli²¹ compared the effectiveness of pharmacotherapy with psychotherapy in schizophrenia showing higher bias in psychotherapy and more severely ill patients in pharmacological studies favoring specific techniques in pharmatherapy and psychotherapy with less competition but cooperation between both professions. At 2-year outcome, Annette Schaub showed a higher level in psychosocial functioning in major depression compared to schizophrenia, however, neither significant differences in rehospitalization rates nor level of knowledge about the disorder^22,23. Kurt Hahlweg developed a family-orientated treatment program for relapse prevention that optimized healthcare in German speaking countries²⁴. Mike Goldstein² and Hahlweg had already proven the effectiveness of family therapy in several empirical studies,^24,25 and recent studies showed the importance of research in high expressed emotion.²⁶

In summary, psychoeducation, communication, and problem-solving skills, as well as relapse prevention, are important for current treatment programmes. Further research, as well as more training for professionals on effective family interventions, seems necessary,²⁷ as well as novel techniques that need to be adopted to this current virtual age. Looking at the differing working groups, there is much overlap in multidisciplinarity, however, some heterogeneity in the importance of machine learning. A pandemic already caused problems in Kraepelin’ times; however, this meeting proved beyond doubt that this current pandemic could not and will not separate the expert scientific community in their ongoing stride for optimizing research on mental health.

Acknowledgments

The Eighth Kraepelin Symposium was held at the Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich on December 9,2020. Altogether12 working groups from Australia, the United States and Europe reported on various areas of interest in lifespan covering primary, secondary, and tertiary prevention in schizophrenia. Experts were Andreas Meyer Lindenberg, MD, Center for Seelische Gesundheit, Mannheim; Elisabeth Binder, MD, Max-Planck-Institute Psychiatry, Munich; Thomas Ehring, PhD, Ludwig-Maximilians-University, Munich; Patrick McGorry, MD, University of Melbourne, Australia; Ilona Kambeitz-Iancovic, PhD, University of Cologne; Philippa Garety, PhD, Kings College London, Great Britain; Brandon A. Gaudiano, PhD, Brown University, Rhode Island, USA; Nico Koutsouleris, MD, Hospital LMU, Munich; William Carpenter, MD, University of Maryland School of Medicine, Baltimore, USA; Kim T. Mueser, PhD, Center for Psychiatric Rehabilitation, Boston University, USA; Stephan Leucht, MD, and Irene Bighelli, PhD, Department of Psychiatry and Psychotherapy, Technical University of Munich; Kurt Hahlweg, PhD, Technical University Braunschweig. This symposium was divided into the following four parts. Translation from mechanism to mental health practices included basic research in psychopharmacological and psychological targets in trauma and its translation in mental health practices. Reports related to the prevention of psychoses and controversies in clinical high-risk cases: pharmacological and psychological therapeutics and the role of machine learning in advancing knowledge for prevention. Evidence advancing understanding and treatment in later phases of psychoses based on meta-analysis and living guidelines. The authors have declared that there are no conflicts of interest in relation to the subject of this study.

Funding

The international meeting Eighth Kraepelin Symposium Translation in Psychiatry and Psychotherapy: A Lifelong Necessity held in Munich on December 9, 2020, was funded by the German Research Foundation (SCHA 1942/3-1).

References