European Psychiatry - Volume 33 - March 2016

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S24 24th European Congress of Psychiatry / European Psychiatry 33S (2016) S18–S55
and the meanings given to illness. Due to increasing migration and
globalisation the challenge of considering diagnosis in the con-
text of culture has become increasingly significant in Europe. And
globalization has further led to changes in value systems and our
awareness of patients with ethnic minority background.
Over recent decades, there has been an increasing development of
psychiatric diagnosing with nosological categorisation combined
with multi-axial schemas. Diagnosis, besides identifying a disorder
and distinguishing one disorder fromanother disorder - differential
diagnosis, has also an aim to include an overall understanding of
the patient’s situation.
We witness an upsurge in the attention paid to the cultural limita-
tions to psychiatric diagnostic practice and treatment modalities.
Guidelines for the psychiatric profession are in critical focus from
a transcultural perspective. Some claim their universality indepen-
dent of cultural context; others find cultural adaptation useful and
necessary.
Do the diagnoses and clinical and ethical guidelines give mean-
ing in the cultural setting? Are they compatible with the cultural
values of the therapist and those of the patient and the family? Sev-
eral sources claim the biomedical paradigm for beingWestern with
insufficient consideration of the socio-political context.
The cultural formulation developed as part of DSM-IV and now
DSM-5 is one model to support a systematic review of culture and
context in psychiatric diagnosing.
The paper will discuss the advantages and shortcomings of cur-
rent diagnostic categories and guidelines vis-à-vis the universe of
traumatized refugees with other ethnic backgrounds.
URL:
Disclosure of interest The author has not supplied his declaration
of competing interest.
S22
Interview and therapeutic rapport in
diagnostic process
L. Küey
Istanbul Bilgi University, Department of Psychology, Istanbul, Turkey
Diagnostic assessment in psychiatry, as a formulation and as a joint
re-construction process between the clinician and the patient, is
essential in clinical care. Clinical interview is the crucial tool of the
clinician in this process. Accordingly, a two-fold task is faced. On
one hand, the clinician is in need of making a comprehensive diag-
nostic assessment to construct a valid and working formulation of
the patient’s situation and a treatment plan.
On the other hand, the bases for a psychotherapeutic alliance
and rapport should be established. A comprehensive diagnos-
tic assessment aims to bridge the current scientific evidence
and knowledge with the uniqueness of the specific person who
presents for care. The clinician facing the complexities of the
human existence in health and ill mental health constructs work-
ing hypotheses in the context of the interview, to understand and
formulate the psychopathological state. Clinical interview serv-
ing as a practical channel in constructing these hypotheses, also
serves as the main tool in establishing a therapeutic alliance.
The theory and practice of different schools of psychotherapies
offer considerable contributions to the clinician in managing these
tasks.
Understanding the meaning of the human suffering through empa-
thy in a judgment free milieu is essential in the establishment of
rapport, compliance and a better clinical outcome. This presenta-
tion will discuss the complexity of diagnostic process in psychiatry
and emphasize the contributions of psychotherapeutic theory and
skills and humanistic approaches in this process. Brief clinical
vignettes from the authors’ clinical practice will be used to broaden
the scope of discussion.
Disclosure of interest The author has not supplied his declaration
of competing interest.
Does diet affect mental health? The role of the
gut-brain axis in psychiatric disorders
S23
The role of IgG hypersensitivity and
changes in gut microbiota in the
pathogenesis and therapy of
depressive disorders
H. Karakula-Juchnowicz ∗, P. Szachta , D. Juchnowicz ,
S. Grochowski , M. Gał˛ecka
1 Medical University, Department of Clinical Neuropsychiatry I,
Department of Psychiatry-Psychotherapy and Early Intervention,
Lublin, Poland
2 VitaImmun Medical Center, Research Department, Poznan, Poland
3 Medical University of Lublin, Department of Psychiatric Nursing,
Lublin, Poland
4 Privat Practice New York, Anti-aging and Functional Medicine, New
York, USA
5 Institute for Microecology, Research Department, Poznan, Poland
∗ Corresponding author.
Depression is a complex, heterogeneous psychiatric disorder
with multifactorial aetiology. Substantial evidence indicates that
depressive episodes are associated not only with changes in neu-
rotransmission in the central nervous system (CNS), but also may
lead to structural changes in the brain through neuroendocrine,
inflammatory, and immunological mechanisms. Among the factors
deserving special attention connected with developing systematic
inflammation are altered intestinal permeability, IgG food intoler-
ance, and changes in gut microbiota.
We present a possible scenario of the development of depres-
sion, linking elevated zonulin production, loosening of the tight
junction barrier, an increase in permeability of the gut wall, and
the passage of macromolecules, normally staying the gut, into
the bloodstream, with the immuno-inflammatory cascade and
induction of IgG-dependent food sensitivity. Alterations in bidirec-
tional signaling between the gastrointestinal tract and the brain, so
called “microbiota–gut–brain axis”, may be normalized by dietary
immunomodulating factors, including prebiotics and probiotics. In
the case of increased IgG concentrations, the implementation of
an elimination–rotation diet may prove to be an effective method
of reducing inflammation and, in this way, alleviating depressive
symptoms.
Given complexity and variety of mood disorders, it is necessary
to develop improved integration models. Preliminary study results
raise hope that the new methods mentioned above, i.e. psychobi-
otics, prebiotics, an elimination-rotation diet, may be an important
addition to the psychiatrist’s armamentariumas therapeutic agents
improving the efficacy of the treatment for affective disorders
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
References
[1] Karakuła-Juchnowicz H, Szachta P, Opolska A, Morylowska-
Topolska J, Gał˛ecka M, Juchnowicz D, et al. The role of IgG
hypersensitivity in the pathogenesis and therapy of depressive
disorders. Nutr Neurosci 2015.
[2] Kelly JR, Kennedy PJ, Cryan JF, Dinan TG, Clarke G, Hyland NP.
Breaking down the barriers: the gut microbiome, intestinal