From youth mental health to difficult-to-treat depression, from precision psychiatry to brain health: in Naples the European Psychiatric Association discussed how to bring into services what research has already shown, while keeping it distinct from what still needs validation.
Early intervention in psychiatry is the set of strategies aimed at recognising and treating a mental disorder as early as possible, ideally at its first signs, in order to reduce its duration, its severity and its impact on a person’s functioning. This was the common thread of the EPA Regional Meeting “Psychiatry in Action”, the first regional congress of the European Psychiatric Association (EPA), the association representing more than 80,000 psychiatrists in Europe, held in Naples from 28 to 30 October 2026 under the presidency of Andrea Fiorillo, President of the EPA. The programme included five educational courses, more than 40 scientific sessions across symposia, mini-symposia, workshops and update lectures, and over 100 e-posters. The stated goal, in the President’s words, was “to transfer research results into clinical practice, distinguishing what is already applicable from what is still being validated”. In the fields of clinical, biological and social psychiatry, Springer Nature publishes, among others, European Archives of Psychiatry and Clinical Neuroscience and Social Psychiatry and Psychiatric Epidemiology, while the neurological side of brain health is covered by Neurological Sciences, the official journal of the Italian Society of Neurology.
Why has early intervention become a priority?
Because mental disorders begin early and appropriate care often arrives late. According to the World Health Organization, half of all mental disorders emerge by the age of 14 and three out of four by the age of 24. The largest available meta-analysis on age at onset confirms this picture with slightly different estimates: about one third of people who will develop a mental disorder do so before 14, almost half before 18 and more than 60% before 25, with a peak age at onset of around 14 and a half [1]. The authors noted that these curves challenge the organisation of services built on a sharp divide at age 18 between child and adolescent psychiatry and adult psychiatry [1].
The overall burden is substantial. Global Burden of Disease analyses indicate that mental disorders remain among the ten leading causes of disease burden worldwide and that, since 1990, there has been no global reduction in this burden, despite the availability of effective interventions [2]. Depression and anxiety disorders are the conditions contributing most to disability, with a higher burden in women [2]. In Italy, according to the PASSI (Progressi delle Aziende Sanitarie per la Salute in Italia) and PASSI d’Argento surveillance systems of the Istituto Superiore di Sanità (the Italian National Institute of Health), in 2023-2024 just over 6% of adults and about 9% of people aged over 65 reported depressive symptoms. This proportion is even higher among people with financial difficulties and among those living with a chronic disease, additionally only two in three people with depressive symptoms seek help from others.
Youth and the transition to adulthood: where do care pathways get interrupted?
The most fragile point proved to be the move from child and adolescent services to adult services, one of the moments when care pathways are most often interrupted. The congress devoted an update lecture and a dedicated mini-symposium to mental disorders during the transition from adolescence to adulthood, as well as a symposium on trauma-related psychopathology in young people, from clinical phenotypes to the most recent treatments, and sessions on promoting mental health and resilience among university students, who are exposed to burnout and loneliness.
The focus on developmental age also covered mood disorders in childhood and adolescence, with an educational course on new clinical practice guidelines, and a transdiagnostic approach to early psychopathology, which looks at risk trajectories rather than single diagnostic categories. Alongside these topics, the programme addressed emerging phenomena such as extreme social withdrawal, known by the Japanese term hikikomori, and eco-anxiety, that is, anxiety related to the climate crisis, including the results of an Italian multicentre study [3]. These are areas in which the clinical description is still evolving and the evidence on interventions is preliminary.
The EPA President linked prevention to a rethinking of how services are organised. In an interview given to Medici Oggi on the eve of the congress (“The brain knows no boundaries between specialties”, in Italian), Fiorillo acknowledged the historical role of Italy’s Law 180 in community psychiatry, while arguing that it needs updating towards prevention and public mental health, starting from schools and workplaces, because “managing disorders that are already present is not enough”.
Depression: why does timing matter and how is treatment personalised?
In major depression, timeliness is one of the few solid prognostic factors. A review of outcome predictors showed that a longer duration of untreated depression is associated with worse outcomes. On the contrary, early improvement in the first weeks of treatment is associated with a higher likelihood of response and remission. The presence of psychiatric and somatic comorbidities prolong the course of the illness [4]. The same authors stressed that depression remains underdiagnosed and undertreated and that structured, sequential, guideline-based treatment strategies are among the most practical tools for improving outcomes [4].
In Naples these issues were addressed in a psychopharmacology update session on the management of depressive disorders, bipolar disorder in its stable phase and schizophrenia spectrum disorders, and in an educational course on the art of prescribing antidepressants. The underlying message was that the choice of treatment should be tailored to the individual patient, taking into account predominant symptoms, comorbidities, tolerability and preferences, and that long-term continuity of treatment, with careful monitoring of adherence and side effects, is an integral part of care. “There is no drug that works for everyone,” Fiorillo recalled in the interview, noting that depression is not a single disease and that different biological bases may require different treatments.
Considerable space was also given to options for difficult-to-treat depression, that is, depression that does not respond adequately to several properly conducted treatment attempts. The programme included an update on the clinical effects and neurobiological mechanisms of rapid-acting antidepressants, a mini-symposium on new pharmacological approaches to depression and schizophrenia, including drugs that do not act by directly blocking dopamine receptors, and a symposium on transcranial magnetic stimulation, a non-invasive neuromodulation technique, beyond mood disorders. For these options the evidence is growing, but their place in care pathways, patient selection and sustainability within services are still being assessed.
Precision psychiatry: what is already applicable and what is not?
For now, precision psychiatry is mainly a research programme, with few applications ready for routine clinical use. “We are moving from promise to clinical testing,” Fiorillo told Medici Oggi, adding that the field is not yet mature and requires cultural change, investment and attention to costs. Examples mentioned in the congress press release include stratifying patients with depression on the basis of inflammatory markers, clinical and genetic predictors of response to lithium, and language analysis as a possible biomarker in psychoses and affective disorders.
The inflammatory hypothesis is the one with the most developed biological rationale. Evidence gathered over the past twenty years indicates that immune mechanisms may contribute to the pathogenesis of major depression in a subset of patients, and that people with elevated pro-inflammatory markers tend to respond less well to conventional antidepressants [5]. Defining biologically based subgroups could increase response rates, but the useful markers, the thresholds and the targeted treatments are still under investigation, and no test is currently recommended for practice [5]. Neuroimaging markers and levels of neurotrophic factors have also been studied as outcome predictors, but their integration into routine care has not yet been clarified [5].
Lithium, the focus of a symposium on the long-term stabilisation of mood disorders, represents the opposite case: a drug with an established role, recognised by the main international guidelines for the maintenance treatment of bipolar disorder, for which research is now trying to identify in advance who will benefit most. Finally, the congress discussed artificial intelligence applied to mental health, weighing its diagnostic and prognostic potential against the risk that algorithms reproduce the biases and inequalities present in the data used to train them.
Brain health: should mind and brain be treated together?
Yes, according to the perspective the EPA brought to Naples, which integrates psychiatry and neurology across the whole lifespan. Two plenary lectures and a dedicated session addressed the relationship between mental health and brain health, defined as the condition in which the brain optimally supports cognitive, emotional and behavioural functions, and a mini-symposium discussed the boundary between psychiatry and neurodegenerative diseases, with biomarker-based approaches to differential diagnosis. “The brain does not recognise the boundaries we have created between specialties,” Fiorillo explained in the interview, referring to the EPA consensus paper “One Brain, One Mind” and to the need to preserve specialist skills while integrating them into training and practice.
For clinicians, this perspective has practical consequences. Depression is common during the course of neurological diseases and of chronic diseases in general, worsens their prognosis and is often recognised late; data from the Istituto Superiore di Sanità confirm that depressive symptoms are more common among people with a chronic condition. The congress also devoted specific sessions to sleep as a core component of mental health: insomnia is a symptom that cuts across many psychiatric disorders, accompanies their onset and relapses and, when it persists, deserves its own assessment and treatment.
Among modifiable factors, the programme discussed lifestyle psychiatry, with interventions on physical activity and nutrition delivered also through digital tools. Digital technology was analysed in both its faces: as a resource for monitoring symptoms and behaviour over time, as Fiorillo noted regarding digital psychiatry and virtual reality, but also as a source of risk, with sessions on digital addictions and the effects of social media.
Suicide, stigma and access to care: which evidence-based responses?
Suicide prevention ran through the entire programme. According to the World Health Organization, suicide is the third leading cause of death worldwide among people aged 15 to 29. Suicide risk arises from the interaction of biological, psychological, clinical, social and environmental factors, and it is precisely this complexity that makes it hard to predict at the individual level [6]. The evidence indicates that the best results come from combining psychological interventions, such as cognitive behavioural therapy, follow-up contacts after a crisis and safety planning, with adequate pharmacological treatment of the underlying disorder. These interventions are complemented by public health strategies, including restricting access to means of suicide and promoting responsible media reporting [6]. Alongside these established interventions, new tools for risk stratification are emerging. Machine learning models for identifying risk were also presented in Naples, a promising field that is still far from validated clinical use, together with a mini-symposium on the transdiagnostic dimensions of self-harm and suicide risk in young adults.
Stigma and misinformation were identified as concrete barriers to accessing care. A mini-symposium discussed how to counter negative attitudes towards psychiatry starting from data on treatment effectiveness, analysing the spread of non-evidence-based interventions on social media. The programme also addressed equity of access to services and the needs of the most vulnerable populations, including migrants, refugees and LGBTQ+ people, a theme that Fiorillo named among the priorities of his presidency together with the mental health of people in prison. The plenary lectures covered the future of the Diagnostic and Statistical Manual of Mental Disorders (DSM), with a talk by the President of the American Psychiatric Association, social psychiatry and the ethical challenges of the profession, while sessions dedicated to early-career psychiatrists discussed training needs and professional migration in Europe.
Key points for clinical practice
A substantial share of mental disorders begins before the age of 18, so attention to early signs in adolescence and during the transition to adulthood is a task that also involves paediatricians, general practitioners and non-psychiatric specialists.
In depression, the length of the untreated period weighs on prognosis: recognising symptoms early and starting guideline-based treatment improves the chances of remission.
Treatment of depression should be personalised and sustained over time, with regular checks on response, adherence and tolerability, and a clear plan for patients who do not respond.
Depressive symptoms are more frequent in people with chronic or neurological diseases and worsen their course, so they should be actively sought in these patients.
Inflammatory markers, genetic tests, language analysis and artificial intelligence algorithms are currently research tools and do not replace clinical assessment.
Suicide prevention works when it combines treatment of the underlying disorder, targeted psychological interventions, continued contact after crises and public health measures.
Acknowledgements
We thank the European Psychiatric Association and the Congress President, Andrea Fiorillo.
References
- Solmi M, Radua J, Olivola M, Croce E, Soardo L, Salazar de Pablo G, et al. Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies. Mol Psychiatry. 2022;27(1):281-95. doi:10.1038/s41380-021-01161-7
- GBD 2019 Mental Disorders Collaborators. Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Psychiatry. 2022;9(2):137-50. doi:10.1016/S2215-0366(21)00395-3
- Mosca A, Luciani D, Chiappini S, Miuli A, PsyClimate Research Group, Cianconi Pet al. Eco-Anxiety and Mental Health: Correlates of Climate Change Distress. Int J Environ Res Public Health. 2025 Nov 21;22(12):1768. doi: 10.3390/ijerph22121768
- Kraus C, Kadriu B, Lanzenberger R, Zarate CA Jr, Kasper S. Prognosis and improved outcomes in major depression: a review. Transl Psychiatry. 2019;9(1):127. doi:10.1038/s41398-019-0460-3
- Drevets WC, Wittenberg GM, Bullmore ET, Manji HK. Immune targets for therapeutic development in depression: towards precision medicine. Nat Rev Drug Discov. 2022;21(3):224-44. doi:10.1038/s41573-021-00368-1
- Turecki G, Brent DA, Gunnell D, O’Connor RC, Oquendo MA, Pirkis J, et al. Suicide and suicide risk. Nat Rev Dis Primers. 2019;5(1):74. doi:10.1038/s41572-019-0121-0
