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Background: Long/post-COVID and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) are often accompanied by fatigue, cognitive impairments and psychological symptoms. Psychiatric and psychotherapeutic care is challenged by unclear evidence, symptomatic overlaps, and controversial treatment recommendations.

Objective: Presentation and comparison of psychiatric and psychotherapeutic recommendations in relevant international and national guidelines on long/post-COVID and ME/CFS, focusing on psychotherapy and psychopharmacotherapy.

Methods: A narrative review was conducted. National and international guidelines focusing on ME/CFS and long/post-COVID published between 2020 and 2025, particularly by the WHO, AWMF, NICE, CDC and IQWiG, were included. The selected guidelines were analyzed in terms of key aspects.

Results: Psychiatric pharmacotherapy is recommended only for comorbid disorders. Psychotherapeutic interventions are mostly recommended as supportive in the guidelines. Activating treatment approaches, such as graded exercise therapy (GET) are generally viewed critically in connection with postexertional malaise (PEM), whereas for patients without PEM, several guidelines explicitly endorse moderate, individually adapted activation. Pacing strategies are highlighted across guidelines as a central concept of activity management.

Discussion: Psychiatric and psychotherapeutic interventions in long/post-COVID and ME/CFS are supportive but not causal treatments. Guidelines recommend symptom-oriented, individualized therapeutic approaches as well as an integrative consideration of somatic, social and psychological factors in the sense of the biopsychosocial model. There is a high need for specific research on psychotherapeutic intervention forms in these patient groups.

Background and objective: In 2023 a total of 57,776 people were imprisoned in German correctional facilities (JVA). According to international studies 50-75% of prison inmates suffer from mental disorders; however, so far there are no well-founded data on the psychiatric psychotherapeutic care situation in German prisons. The survey of the German Society of Psychiatry and Psychotherapy, Psychosomatics and Neurology (DGPPN) is intended to provide an initial insight into the specific service provision.

Material and methods: The online survey was designed as a unique cross-sectional survey. A task force (TF) of the DGPPN developed a questionnaire with 12 topics and 85 items. To reflect the situation in the institutions, the questionnaire was sent to the Criminological Service in advance. Targeted suggestions for improvement were implemented. The survey was conducted with the support of the Prison Committee, a committee of the federal states that, among other things, monitors conditions in prisons, in the period from 1 March-30 April 2024. The questionnaire was sent online and as a printout to the prisons in the federal states via the Prison Committee. The feedback was sent to the DGPPN. Participation in the survey was voluntary and anonymous. The data were evaluated descriptively.

Results: According to the information provided by the 137 (77.8%) institutions participating in the study, 41,173 persons were imprisoned as of 1 March 2024, including prisoners in pretrial detention, sentenced prisoners and preventive detention. Of the participating institutions 86.7% reported problems caring for prisoners with mental disorders. The capacities of full and partial inpatient psychiatric treatment were assessed by most of the institutions as not covering the actual needs. A third of the specialist positions were not filled. In the last 12 months 128 institutions recorded 5812 placements in specially secured detention rooms (15.9% of prisoners).

Discussion: The study confirmed the assumption of experts working in the field of psychiatric-psychotherapeutic care: the resources for the care of prisoners with mental disorders in German prisons are perceived as insufficient. Above all, there is a lack of specialist staff and psychiatric treatment capacities. Sufficient funding to improve the service provision is indispensable. Treatment standards that conform to guidelines should be developed and introduced.

Background: Digital interventions such as de:)press®, a cognitive control training, increasingly supplement standard depression treatment. Psychological factors, such as treatment expectation (TE), gain importance as they can influence user satisfaction (US).

Method: In a randomized controlled trial, the relationship between TE and US was examined in 58 individuals with unipolar depression. The intervention group used de:)press® for 6 weeks. The factors TE (T1), US and usage frequency (UF; T2) were assessed via questionnaires and app data. Mediation and moderation analyses were conducted.

Results: The TE had a significant direct effect on US, which was not mediated by UF. No moderating effect of medication was found. The app received high satisfaction ratings, especially regarding its usability, while the perceived therapeutic effect was rated more moderately.

Conclusion: The findings highlight the relevance of subjective factors such as TE in evaluating digital interventions. Objective usage played a lesser role. Addressing user expectations can enhance the acceptance and effectiveness of digital health applications.

Background: Atypical depression (AD) is a subtype of unipolar depression characterized by mood reactivity, hypersomnia, hyperphagia and interpersonal sensitivity. The concept of immunometabolic depression (IMD) describes a subgroup with additional metabolic and inflammatory abnormalities, such as obesity, insulin resistance and elevated C‑reactive protein (CRP) levels.

Objective: To summarize current evidence on AD, its overlap with immunometabolic mechanisms and therapeutic implications.

Material and methods: Narrative review based on a PubMed search using the terms "atypical depression" and "immunometabolic depression" (IMD), supplemented by relevant review articles.

Results: Atypical depressive syndromes are associated with increased systemic inflammation and metabolic dysregulation. There is evidence suggesting specific efficacy of bupropion and monoamine oxidase (MAO) inhibitors, although overall evidence remains limited. In patients with immunometabolic abnormalities (e.g., elevated C-reactive protein), anti-inflammatory agents (e.g., infliximab) and metabolically active medications (e.g., oral antidiabetic drugs) are discussed as potential treatment options; however, statins have not shown consistent antidepressant effects to date. Physical activity and dietary interventions appear additionally beneficial.

Discussion: The concept of IMD could enable stratified treatment approaches in the future. At present the evidence is inconclusive and no specifically approved treatment is available. Moreover, frequent fluctuation between atypical and melancholic syndromes complicates clinical differentiation.

Background: Arificial Intelligence (AI) is increasingly becoming established in medicine, such as therapeutic chatbots in mental health. Despite this, knowledge about clinicians' views and skills is lacking. This study examines the attitudes toward AI and competencies of German physicians (ÄPT), psychotherapists (PPT) and psychotherapists in training (PiA) for the first time.

Method: Cross-sectional study with online survey (June-July 2025) of 335 participants, recruited through professional associations and chambers. Attitudes were assessed using the AIAS‑4 scale, competencies using the MAILS scale. Statistical analysis using ANCOVA with age as covariate (Bonferroni-corrected).

Results: All professional groups showed moderate AI literacy (M = 4.9-5.9/11), e.g. recognizing and evaluating the use of AI and moderately positive attitudes toward AI (AIAS-Total; M = 5.6-6.3/10). After controlling for age (ANCOVA), professional group effects emerged only for attitudes (p = 0.012), with physicians showing more positive attitudes than both psychologist groups (d = 0.40-0.49) but not for AI literacy (p = 0.267). There was a strong generational effect: younger participants demonstrated higher AI literacy (r = -0.28) and more positive attitudes (items 1-3: r = -0.12 to -0.17). Development competency for AI was almost nonexistent.

Conclusion: The competence of reflective use of AI appears primarily generation-dependent, not profession-specific. Age-adapted, cross-professional training programs are necessary to systematically integrate reflective competencies in education and continuing professional development.

Background: Depressive episodes are associated with a high risk of relapse and recurrence. A precise understanding of the risk factors for recurrence and relapse can prevent poor disease courses through the implementation of early and targeted interventions.

Objective: Description of the factors that increase the risk of recurrence and relapse in major depression.

Material and methods: Narrative literature review.

Results: Risk factors for depressive recurrence and relapse are primarily clinical factors, including the number of previous depressive episodes, a young age at first onset and existing residual symptoms. Environmental factors include childhood maltreatment and current stressors. Intrapsychic factors such as increased neuroticism or dysfunctional cognition also promote relapses and recurrences. Biological factors include functional and structural brain changes, immunological dysregulation and genetic predispositions.

Conclusion: In clinical practice the previous course of illness is the key predictor for individual risk prognosis. Therapeutic interventions should focus on achieving full remission of residual symptoms through combined pharmacological and psychotherapeutic treatment. The vulnerability to recurrence of depressive episodes is multifactorial and the indications for recurrence prevention should reflect this.

Background: On 15 October 2025, the revised S3 guideline on schizophrenia (living) was published and transferred to the MAGICapp evidence ecosystem and will be updated annually in the future.

Objective: This narrative review summarizes essential innovations and explains their development.

Material and methods: New and revised recommendations and MAGICapp background information were extracted and summarized.

Results and conclusion: The guideline is now fully integrated into MAGICapp and annually updated. Key changes include a downgrading of the recommendation for antipsychotic monotherapy, a substantial expansion of guidance on adverse effect monitoring and management and a strengthened emphasis on evidence-based psychotherapeutic interventions, such as metacognitive training and systemic therapy. Additionally, 4 new recommendations (digital/technology-assisted interventions, mindfulness-based procedures, acceptance and commitment therapy [ACT], trauma-focussed therapy for post-traumatic stress disorder [PTSD]) were implemented and 12 were removed. All chapters were comprehensively revised.

Background: First acute episodes or severe recurrent courses of schizophrenia often occur in the age of transition, the transition between the pediatric psychiatric and the adult psychiatric care systems.

Objective: Examination of the challenges and recommendations for the transition of patients with schizophrenia.

Material and methods: A narrative review was carried out taking the current S3 guidelines of the Association of the Scientific Medical Societies in Germany (AWMF) on schizophrenia into consideration.

Results: The guideline-conform early detection and treatment of schizophrenia is already a challenge independent of the transition. Recommendations on the transition period for clinics and private service providers concern elements of the disorder itself, the structure of the healthcare system and specialized training and culture, and the concepts and financial compensation for treatment transitions.

Conclusion: The updated German S3 guidelines on schizophrenia published in 2025 include numerous recommendations for coordinated treatment in the transition phase but in most parts maintain the age cut-off at 18 years. For optimal care in the age for transition, access to specialized early detection and intervention centers is essential. An overlapping treatment during the transition phase and a bidirectional flexibility of age limits within healthcare systems appear to be beneficial in certain cases.