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25th European Congress of Psychiatry / European Psychiatry 41S (2017) S53–S68


Workshop: love, sex and psychiatry: the case of

gender dysphoria


A Dimensional perspective on sexual

orientation and gender

G. Castellini

Universisty of Florence, department of neuroscience- psychology-

drug research and child health, Florence, Italy

Gender identity - the subjective experience of membership to a

gender - is generally taken for granted by most of the persons.

It is part of our general identity, and provides a sense of conti-

nuity of the self, and interrogative on this aspect of our life are

barely present in our consciousness. Exceptions are represented

by stages of development such as adolescence or some categories

of persons who do not identify themselves into the dichotomous

world of men/female. The debate on gender identity recently has

broken into the consciousness for Psychopathology, rising interrog-

atives from different perspectives, including Medicine, Phycology,

Anthropology, and Ethic.

In the present symposium we resume the historical trajectory

of gender definition, emphasizing the importance of a different

perspective on gender than the common definition provided by

western culture. We propose a phenomenological perspective on

the components of sexual identity, which includes anatomical sex,

gender identity, sexual orientation, and gender role. The pheno-

menological approach is coherent with the dimensional view on

sexual identity proposed by the DSM board, as well as by LGBT

movements. This position considers Gender Dysphoria and trans-

sexualism as a pole of gender variants continuum. Phenomenology

looks at the comprehension of subjective gender heterogeneity,

and the subjective world of gender dysphoric persons as the only

way to take care of them; every psychological medical or surgical

treatment should come as consequences. The phenomenological

perspective on gender dysphoria may be useful to understand and

partially explain the different subjective satisfaction to common

hormonal and surgical treatment.

Disclosure of interest

The author has not supplied his declaration

of competing interest.


Gender identity issues in children and


T.D. Steensma

VU university medical center, center of expertise on gender

dysphoria- medical psychology, Amsterdam, The Netherlands

Gender identity issues in children and adolescents.

Gender dysphoria (GD) refers to the significant distress due to the

incongruence between assigned gender at birth and experienced

gender. Over the last decade, the care for prepubescent children

and adolescents with GD is rapidly changing and there is a grow-

ing number of specialized gender clinics for youth. However, the

offered care between countries is very different and the best clini-

cal practice in this population is still controversial and under debate

among dedicated professionals.

The current presentation will focus on providing a clinical picture

of children and adolescents referred to gender identity clinics. For

prepubescent children the focus will be on the present knowl-

edge about the psychosexual development of these children and

treatment & counseling approaches are presented and discussed.

With regard to the adolescents, medical treatment approaches are

presented and discussed, followed by the results from the only

follow-up study on medical treatment in adolescents with GD.

Disclosure of interest

The author has not supplied his declaration

of competing interest.

Workshop: reward circuits, anhedonia and

avolition: brain imaging contribution to their

understanding in schizophrenia


VTA-insula connectivity and avolition

in subjects with schizophrenia

A. Mucci

1 ,

, G.M. Giordano


, M. Stanziano


, M. Papa



S. Galderisi



University of Campania “Luigi Vanvitelli”, department of psychiatry,

Naples, Italy


University of Campania “Luigi Vanvitelli”, laboratory of neuronal

networks- department of mental and physical health and preventive

medicine, Naples, Italy

Corresponding author.


Avolition represents an important domain of nega-

tive symptoms in schizophrenia with a strong impact on functional

outcome. Primary and persistent avolition is refractory to available

pharmacological and psychological treatments. A better under-

standing of its pathophysiological mechanisms is fundamental to

promote development of new treatments. Recent models of avoli-

tion converge on dopaminergic circuits involved in motivation and

its translation in goal-directed behavior. Deficits in task-related

activation or connectivity within mesolimbic and mesocortical

dopamine circuits were reported in schizophrenia but the relation-

ship with avolition was not fully established.


The present study aimed to investigate resting-state func-

tional connectivity (RS-FC) within the motivation circuits in

schizophrenia patients and its relationships with primary and per-

sistent avolition.


RS-FC, using VTA as a seed region, was investigated in

22 healthy controls (HC) and in 26 schizophrenia patients (SCZ)

divided in high (HA) and low avolition (LA) subgroups. Avolition

was assessed using the Schedule for the Deficit Syndrome.


HA, in comparison to LA and HC, showed significantly

reduced RS-FC with the right ventrolateral prefrontal cortex (R-

VLPFC), right insula (R-INS) and right lateral occipital cortex

(R-LOC). The RS-FC of these regions was negatively correlated to



Our findings demonstrate that avolition in

schizophrenia is linked to dysconnection of VTA from key cortical

regions involved in retrieval of outcome values of instrumental

actions to motivate behavior.

Disclosure of interest

AM received honoraria or advisory

board/consulting fees from the following companies: Janssen

Pharmaceuticals, Otsuka, Pfizer and Pierre Fabre. SG received

honoraria or advisory board/consulting fees from the follow-

ing companies: Lundbeck, Janssen Pharmaceuticals, Hoffman-La

Roche, Angelini-Acraf, Otsuka, Pierre Fabre and Gedeon-Richter. All

other Authors declare no potential conflict of interest.