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Background: Due to illness-related functional limitations, a significant proportion of individuals with severe mental illness are dependent on external assistance to navigate their daily lives and achieve an optimal level of independence and wellbeing.

Objectives: The present study sought to investigate the needs, the coverage of needs and the influencing factors among people with severe mental illness in Germany.

Methods: The study included patients diagnosed with severe mental illness. The met and unmet needs, as well as the potential influencing factors, were collected using Camberwell Assessment of Need (CAN) and Client Sociodemographic and Service Receipt Inventory (CSSRI) and subsequently analysed descriptively and exploratively.

Results: The mean number of reported needs was 6.4, with an average of 40.6% of these needs being met. The vast majority of patients (98%) require professional support, which is, from their perspective, inadequate (9-86% depending on the area concerned). Additionally, many patients also receive support from relatives (7-57% depending on the area concerned). The diagnosis, age, functioning, household income, and housing situation have an influence on the number and coverage of needs.

Conclusions: The findings indicate that patients have diverse and complex needs, which are not fully met. Notably, the support provided by professional services is perceived as inadequate.

Background: Sex and gender differences in mental disorders are widespread. Posttraumatic stress disorder (PTSD) is one of the mental disorders with the largest prevalence differences between women and men.

Aim of the paper and methods: This narrative review article highlights the current scientific evidence on sex and gender differences in the development, diagnostics and treatment of PTSD.

Results: Although men more frequently experience traumatic events women have a twofold to threefold higher risk of developing PTSD and experience more severe PTSD symptoms than men. The increased vulnerability of women is not yet fully understood and can be attributed to a combination of biological and psychosocial factors. Despite the higher risk, women and female-specific risk factors are underrepresented in relevant research, a gender data gap exists. Men are more likely to experience accidental and weapon-related trauma and women are more likely to be exposed to sexual violence. While women more frequently suffer from comorbid anxiety and affective disorders, PTSD in men occurs more frequently in combination with substance abuse. Men with PTSD are less likely to seek psychotherapeutic help than women and benefit less from evidence-based trauma-focused interventions.

Discussion: The differential consideration of biological and psychosocial factors is crucial to understanding sex and gender differences in PTSD. Sex and gender-sensitive approaches in diagnostics and treatment as well as the consideration of sex/gender beyond binary classifications can help to close knowledge gaps and enable more targeted care.

Background: The German psychiatrist Emil Kraepelin (1856-1926) developed a nosology of mental illnesses, the main features of which are still valid today, particularly in the form of the differentiation between the affective and schizophrenic forms. However, little is known about his work on neuroses.

Objective: What development did Kraepelin's concept of neurosis undergo, especially with respect to its etiological theories, symptom complexes, basic characteristics and thus also included or excluded disorders? Which influencing factors played a decisive role in each case?

Material and methods: All neurosis-specific chapters of the 1st to 8th editions of Kraepelin's psychiatry textbook published between 1883 and 1915 were analyzed, compared and examined for changes and their motivations for change.

Results: The neurosis concept established in the 2nd edition is retained in its basic features until the 6th edition. In the 7th edition Kraepelin breaks with his original conception due to a lack of selectivity and only retains one subgroup: the "psychogenic neuroses". This was continued in the 8th edition under the name of "psychogenic disorders" and expanded to include new disorders.

Conclusion: Both social and professional neurological influencing factors can be identified for the development of Kraepelin's concept of neuroses.

Background: To date there has been no evaluation of further training and working conditions in medical specialist training in psychiatry and psychotherapy in Germany. In order to counteract the lack of young talent and ensure long-term care for patients, quality assurance is essential.

Aim of the work: The evaluation aims to identify strengths and weaknesses of the further training and to derive measures for improvement. For a better classification, a comparison is also made with other disciplines with medical specialist further training.

Material and methods: The online-based survey took place from 15 May 2023 to 30 June 2023. The results refer to 315 questionnaires from 202 physicians in further training and 113 medical specialists (specialist title for less than 3 years).

Results: Of those surveyed 64% were satisfied with the quality and implementation of the general psychiatry part, only 11% were considering changing their specialty and 18% were considering moving their job abroad due to the training conditions. There is a need for improvement in induction and in the organization of the training. In addition, significant time and financial burdens for mandatory external training events as well as the lack of compatibility between training and research, teaching and care work responsibilities were criticized.

Discussion: Overall, it appears that the working conditions are better than in other disciplines. With respect to the potential for improvement, the creation of financing for further training is essential; certificates for high quality training and the publication of positive examples can also contribute to quality assurance and improvement.

Aggressive behavior shows striking gender differences. Cross-cultural research shows that men are more likely to engage in physical aggression, while women tend to use indirect forms of aggressive behavior. Aggression is a multifactorial phenomenon influenced by situational, genetic, psychological and other factors. Despite being a transdiagnostic feature in numerous mental disorders, gender-specific differences and the underlying influencing factors have not yet been sufficiently investigated. Many findings originate from older publications and methodologically sound and in particular behavior-based investigations are rare. This article provides a narrative literature review that summarizes the current state of research on gender differences in aggression in selected mental disorders, including substance use disorders, psychotic disorders and borderline personality disorder. The implications for future research and the clinical practice are discussed.

Psychocardiology is a medical discipline that focuses on the interaction between cardiovascular diseases and mental disorders. Depression and anxiety disorders are common comorbidities in both acute and chronic cardiovascular conditions, while cardiovascular diseases significantly contribute to the premature mortality of patients with severe mental disorders. Therefore, in cases of severe mental illness, screening for the presence of cardiovascular disease or its risk factors is recommended and vice versa. The treatment of psychocardiological patients follows established clinical guidelines and consists of psychoeducation, psychotherapy and/or psychopharmacological treatment depending on the severity.

Background: Adverse childhood experiences (ACE) are a risk factor for an unfavorable lifestyle, mental disorders and cardiometabolic diseases. However, the mechanisms through which these risks are mediated have not been conclusively investigated.

Research question: Is there a connection between ACE and cardiovascular health in adults with congenital heart disease (ACHD)?

Methods: A total of 609 ACHD were included. Sociodemographic parameters, ACE (Childhood Trauma Questionnaire, CTQ), depressive symptoms (Hospital Anxiety and Depression Scale, HADS) and physical activity were assessed. Patients underwent a full cardiological examination including the measurement of epicardial adipose tissue (EAT) using echocardiography. Bootstrapped mediation analyses were performed with ACE as the predictor, depressive symptoms and physical activity as mediators and EAT as the dependent variable.

Results: The CTQ sum score showed a significant indirect effect on EAT, which was serially mediated by depressive symptoms and physical activity (CTQ → HADS-D → Exercise → EAT; a*d*b2 = 0.0171, 95% confidence interval, CI 0.0080, 0.0285). Comparable significant effects were found for the individual CTQ domains (emotional/physical neglect, emotional/physical abuse, sexual trauma).

Discussion: We show that ACE are associated with increased depressive symptoms, which in turn lead to reduced physical activity and increased EAT, a risk marker for cardiac events. Our findings point to a key mechanism through which ACE impair cardiovascular health and highlight several targets for primary and secondary preventive interventions within a multimodal treatment approach for ACHD.