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Background: In Germany, there are hardly any studies that investigated the care pathways in the early course of psychosis and the duration of untreated psychosis (DUP) and took the migration background into account.

Objective: The study examined whether young adults with (PwM) and without a migration background (PoM) who had a first psychotic episode or first contact with the psychiatric care system within the last 5 years differ in their utilization of care services and DUP.

Material and methods: The data collection and post hoc analyses were carried out as a part of a cohort study (84 inpatients) at the Early Intervention and Therapy Center (FRITZ) in Berlin.

Results: The number of PwM (n = 38) who experienced a first psychotic episode did not significantly differ from the comparison group (PoM, n = 46) in the utilization of healthcare services (p = 0.22). Neither the time until seeking help from the first service nor the number of contacts with healthcare services and DUP significantly differed between PwM and Pom. The PwM were predominantly young adults with a good education background who grew up in Germany.

Discussion: Users sought help at FRITZ relatively quickly, independent of their migration background, which supports further implementation of specialized early detection and intervention services in Germany. The results could be attributed to the selection of the study population.

Conclusion: Further studies are needed that address people with lower education and low language skills. The early detection programs and awareness campaigns should be adapted to this target group.

Background: Novel antidepressive substances are challenging the explanations for the mechanisms of action of traditional psychopharmacology.

Objective: What could be the shared effects of various antidepressants and in this context what role do extrapharmacological factors, such as the body and environment, play?

Material and method: The available literature on clinical and preclinical data for assumed combined active factors of serotonergic psychedelic drugs, (es)ketamine, monoaminergic antidepressants and zuranolone are presented and the influence of context factors on the individual mechanisms of action is discussed.

Results: There are many indications that classical and novel pharmacological approaches could share similar mechanisms of action in the treatment of depression. These mechanisms favor long-term neuroplasticity, which can trigger subsequent molecular cascades and vice versa. Furthermore, an improvement in the negative bias in emotional processing could be detected for most antidepressive substances. The influence of extrapharmacological factors appears to be necessary so that the biopsychological alterations can have an antidepressive effect.

Conclusion: Instead of attributing factors such as environment, body and social interaction to placebo effects, they should be tested as essential components of the antidepressive effect and considered in the clinical practice.

Background: Bipolar disorder (short: BD) is a severe illness with very heterogeneous trajectories. While some of the patients show no or hardly any long-term impairments, other affected individuals show substantial neurocognitive deficits with a clear decline in psychosocial functioning. Which factors influence the course of the disease is the subject of current research efforts.

Objective: This review presents the long-term course of bipolar disease and the factors influencing it. In particular, differential trajectory types are discussed. The cognitive and psychosocial functional level as well as the psychopathological characteristics of the disease are elucidated. In addition, biological factors and treatment approaches influencing the course and prognosis are identified.

Material and methods: Literature search using PubMed focusing on longitudinal studies over several years (see online supplement).

Results: To date, there are only a few predictors and biomarkers that allow prediction of long-term progression. None have been sufficiently studied to enable clinical use. Appropriate pharmacological and psychotherapeutic treatment of those affected is essential to avoid renewed episodes of the disease.

Discussion: The long-term course of bipolar disorder is highly heterogeneous and multifaceted. Despite intensive research efforts, no predictors have yet been identified that reliably predict the clinical course. This makes further research all the more important in order to offer individualized therapy options, develop new therapies and positively influence the course of the disease at an early stage.

Background: At present there is no comprehensive overview of the long-term development of the clinical picture, disease-associated impairments and neurobiological correlates of anxiety disorders as well as what influence certain risk factors and treatment have on the prognosis.

Objective: This article presents findings regarding disorder-specific symptoms and disorder-associated changes in the areas of functional level, quality of life, neurocognitive performance and structural brain anatomy over the lifespan. It also reports on how patient-related and environment-related aspects as well as guideline-oriented therapy influence the course of the disorder.

Material and methods: A literature search was conducted in PubMed on the aspects of individual components. Meta-analyses, longitudinal and cohort studies were included. To illustrate changes over time, the findings were predominantly presented separately for children and adolescents as well as for early and late adulthood.

Results: Anxiety disorders primarily exhibit age-associated differences in the symptom profile but also in the areas of functional level and quality of life. Risk factors for an unfavorable course of the disorder were identified particularly for young and middle-aged people; however, the findings indicate that evidence-based psychotherapy or pharmacotherapy also has a lasting effect even after termination.

Conclusion: For long-term therapeutic success, age-dependent characteristics and limitations as well as prognostically relevant aspects in the diagnostics and treatment of anxiety disorders should be taken into consideration and treatment should be started as soon as possible.

Despite classical conceptions of schizophrenia as a progressive illness with a high chronification, current long-term follow-up studies show a higher proportion of remission, possibly also a higher proportion of recovery than previously assumed. The heterogeneity of clinical courses is also reflected in different trajectories of cognitive and biological (e.g., imaging) variables, in which many of those affected show remission. Early clinical intervention during the first weeks and months following the onset of psychosis are decisive not only for early remission but also possibly for the long-term outcome. The treatment and reduction of somatic comorbidities are promising approaches in addition to a differentiated core treatment to positively influence the course of the illness even years after the disease. The identification of additional predictors, e.g., based on biological parameters, can together with machine learning approaches contribute to optimization of an individualized core treatment.

Cognitive disorders are multifaceted and the range of neuropsychological instruments is correspondingly extensive; however, most examiners have to limit themselves to a small selection in order to master them safely. In geriatric patients the various forms and stages of dementia dominate. Delirium must be distinguished from these as an acute life-threatening event. The personal and external medical history as well as clinical observation are the first steps in the assessment of cognition; the selection of test procedures is graduated and bears the patient's benefit in mind. When compiling a toolbox for use in one's own field of work, in addition to instruments focusing on different degrees of severity, alternatives should also be considered for use in the presence of comorbidities that reduce the validity (visual, hearing and fine motor disorders) and the examination situation should be taken into account.