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25th European Congress of Psychiatry / European Psychiatry 41S (2017) S8–S52



Neurobiological correlates of learning

and decision-making in alcohol


M. Sebold

1 ,

, S. Nebe


, M. Garbusow


, D. Schad


, C. Sommer



M. Rapp


, M. Smolka


, Q. Huys


, F. Schlagenhauf


, A. Heinz



Charité - Universtitätsmedizin Berlin, Department of Psychiatry and

Psychotherapy, Berlin, Germany


TU Dresden, System Neuroscience, Dresden, Germany


University of Potsdam, Sport - und Gesundheitswissenschaften,

Potsdam, Germany


TU Dresden, Universitätsklinikum Carl Gustav Carus, Dresden,



ETH Zürich and University of Zürich, Translational Neuromodeling

Unit, Zurich, Switzerland

Corresponding author.

The mesolimbic dopaminergic system has been implicated in two

kinds of reward processing, one in reinforcement learning (e.g pre-

diction error) and another in incentive salience attribution (e.g.

cue-reactivity). Both functions have been implicated in alcohol

dependence with the former contributing to the persistence of

chronic alcohol intake despite severe negative consequences and

the latter playing a crucial role in cue-induced craving and relapse.

The bicentric study “Learning in alcohol dependence (LeAD)”

aims to bridge a gap between these processes by investigating

reinforcement learning mechanisms and the influence that Pavlo-

vian cues exert over behavior. We here demonstrate that alcohol

dependent subjects showalterations in goal-directed, model-based

reinforcement learning (Sebold et al., 2014) and demonstrate that

prospective relapsing patients show reductions in the medial pre-

frontal cortex activation during goal-directed control. Moreover

we show that in alcohol dependent patients compared to healthy

controls, Pavlovian cues exert pronounced control over behav-

ior (Garbusow et al., 2016). Again, prospective relapsing patients

showed increased Nucleus accumbens activation during these cue-

induced responses. These findings point to an important role of

the mesolimbic dopaminergic system as a predictor of treatment

outcome in alcohol dependence.

Disclosure of interest

The authors have not supplied their decla-

ration of competing interest.

Symposium: Assisted suicide: An issue for old age



Euthanasia, physician assisted suicide

in the Netherlands in dementia and

late life psychiatric illness

M. Stek

The Netherlands


Although controversial in many countries, in The

Netherlands euthanasia or physician assisted death has increased

in patients with early stages of dementia, psychiatric illness and in

conditions described as ‘being tired of life’ in the oldest old. There

is a strong debate about this practice in the community and among

professionals often with exclamation marks ranging from medical

murder to providing ultimate care.


To provide figures, describe current practice and

debate in The Netherlands with regard to capacity evaluation in

older psychiatric patients and end of life questions.


Review of literature, case reports and own experience

in the past decade.

Result and conclusion

There are few studies on the important

issue of capacity making in psychiatric patients. The research that

was performed does not show that a high threshold of capacity is

required for granting euthanasia. Research on physician-assisted

death in early dementia is scarce. With regard to end of life ques-

tions the debate in The Netherlands is still ongoing.

Disclosure of interest

The author has not supplied his declaration

of competing interest.


Suicide and assisted suicide in

Switzerland: Consequences for suicide


G. Stoppe

MentAge, Basel, Switzerland

As in other countries, in Switzerland, the rate of suicide is highest in

the elderly. Assisted suicide is allowed and mostly exerted by pri-

vate organizations like EXIT. The number of assisted suicide cases

has doubled during the last five years and is expected to increase. It

is mainly committed by women. In the age group 80 + y the number

is higher than the number of suicides. To reduce the number of sui-

cides by 25% by 2030, the federal authorities have issued a national

action plan in November 2016. It includes preventive means like

reduction of access to methods (weapons, drugs), construction of

bridges and buildings, education of lays and professionals and spe-

cific treatment of thosewho have attempted suicide. There has been

a position paper of Swiss public health concerning suicide preven-

tion in the elderly. Both papers will be presented and discussed.

Concerning assisted suicide there is a broad discussion on the con-

trol of the state and on the role of physicians in the process. A survey

of Swiss physicians showed much ambivalence. Position papers of

gerontological and geriatric societies focused on the role loneliness

and the provision of adequate psychiatric help, e.g. for depression,

and the overestimation of autonomy.

Disclosure of interest

The author has not supplied his declaration

of competing interest.


Mental health and social care

providers facing requests of assisted

suicide from elderly in nursing homes

in Switzerland

D.A. Castelli Dransart

1 ,

, S. Voélin


, S. Elena



University of Applied Sciences and Arts Western Switzerland-

School of Social Work Fribourg, Research and Development, Givisiez,



University of Applied Sciences and Arts Western Switzerland-

School of Social Work Geneva, Research, Geneva, Switzerland

Corresponding author.


In some Swiss states, right-to-die associations are

allowed to assist older people in nursing homes provided that cer-

tain requirements are fulfilled.


To investigate how health and social care providers

and their institutions reacted to and dealt with requests of assisted



An exploratory qualitative study was carried out in the

States of Fribourg and Vaud among 40 professionals working in

nursing homes, home care services or social welfare agencies.


The requests of assisted suicide questioned the profes-

sional mission, the quality of accompaniment provided to the older

people and both professional and personal values. Health and social