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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: Descriptions of long-term histories of alcohol dependence provide insight into the etiology, prevention and care.

Objective: Report of empirical findings about the development into and remission from alcohol dependence.

Method: Narrative literature review, analysis of findings from cohort studies in the general population.

Results: Risk factors provide the opportunity to estimate increased probabilities of developing an alcohol dependence. Adolescents disclosed symptoms of alcohol dependence within 8 years after the first alcohol consumption. Alcohol dependence is related to a life expectancy 17.6 years fewer than in the general population. Data of a general population sample revealed a risk of early death 2.8 times higher than among people without mental disorders. The severity of alcohol dependence was shown to be a predictor of premature death. Nicotine dependence can add to the shortening of life in addition to alcohol dependence. Among the alcohol dependent residents in a general population sample, 90.2% did not have utilized detoxification treatment that included motivational treatment and 78.4% did not have utilized standard detoxification treatment in a psychiatric treatment facility. Remission without formal help has been proven. It is the main route of remission.

Conclusion: To reduce unfavorable courses of alcohol dependence, prevention and treatment should be focused more on the needs in the general population. In psychiatric and other medical routine care, screening and an appropriate brief intervention should be carried out.

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: The participation of representatives of patients and relatives in the development of guidelines is of central importance for the quality, feasibility and acceptance of guidelines. In Germany this has not been sufficiently implemented in the discipline of psychiatry, although in practice there are many examples for the benefits of the expertise of people with psychiatric experience.

Objective: The article describes the development and a first process evaluation of a trialogical working group (AG Impuls) accompanying the guideline process. Possibilities for further development and implementation are discussed.

Methods: Description of the working process of the Impuls working group as well as the results of the satisfaction survey after 18 months and summarised content analysis.

Results: Concept: during the further development of the S3 guidelines on psychosocial therapies, the expertise of 12 experts is bundled in the Impuls working group and supported by the members of the steering group. An open discussion takes place in regular digital working meetings and face to face meetings are held once a year as part of the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) congress. The results are presented to the guideline committee at the consensus conferences. Text boxes from the Impuls working group constitute an important tool.

Evaluation: the following topics were identified in connection with the participatory work: (a) exchange at eye level, broadening perspectives and contributing impulses, (b) giving a voice to experienced experts, (c) implementation requirements and possibilities and (d) limitations of the cooperation. Various preconditions and implementation requirements for long-term successful participation in guideline development were identified.

Conclusion: The Impuls working group can be used to specifically address insufficient participation in guideline processes. The structured approach could form a blueprint for other guideline processes.

Background: The definition of long-term courses of depression is heterogeneous. Chronic and treatment-resistant courses, in particular, represent a high-cost factor and greatly reduce the quality of life. Based on the pharmacotherapeutic treatment-resistant depression (TRD), more and more systemic approaches are becoming important.

Objective: This narrative review provides an overview of the long-term course of depressive disorders, including various definitions and influencing factors. In addition, an overview of biomarker research on treatment response with a focus on neuroimaging is presented.

Material and methods: A selective literature search was conducted in PubMed and Google Scholar for a narrative review. Particular attention was given to larger cohort studies, systematic reviews, meta-analyses and studies on the prediction of treatment response.

Results: Chronic and treatment-resistant courses mean a relevant reduction in the quality of life and increased health risks. The assessment of treatment response is a definitional challenge: An alternative to TRD is the systemically oriented difficult to treat depression (DTD). The focus is thus moving away from symptom reduction towards controlling the level of functioning. Biomarker research for treatment response offers potential but currently mainly serves to gain theoretical knowledge.

Conclusion: Recording the long-term course of depressive illnesses is important, but also complex. Clinical interventions should therefore include a continuous monitoring and the focus on maintaining the quality of life.

The adult form of attention deficit hyperactivity disorder (ADHD) has increasingly become a focus of adult psychiatry. Despite long-established diagnostic criteria and specific therapeutic approaches for the disorder, the common misconception that ADHD is a "fad" has persisted. Examining the history of psychiatry can make an educational contribution by showing that the adult form of ADHD is a continuously existing illness phenomenon. The present study examines the discussion of sometimes prominent authors about "chronic mania" in German-speaking psychiatry around 1900. The individual concepts were analyzed for their content and compared with each other and with modern diagnostic manuals for adult ADHD. The aim of this work is to question and discuss whether these "chronic-manic concepts" are part of the conceptual history of adult ADHD and whether a gap in the history of this disorder can be filled with their help. It is concluded that in the early twentieth century neurologists reported and discussed about patients who nowadays would almost certainly receive the diagnosis of ADHD. The psychiatrists had difficulty in classifying this disorder into their nosological schemes but their "chronic-manic concepts" show clear parallels to the current diagnostic criteria for adult ADHD and its symptoms.

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.