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Background: The care of mentally ill people should be carried out in a timely, needs-based and community-based manner. The structure of the outpatient care is a cornerstone in achieving this goal. Against this background, this study presents the development of psychotherapeutic care in Saxony.

Methods: Data on outpatient psychotherapy between 2014 and 2023 from the medical register of the Saxony Association of Statutory Health Insurance Physicians were retrospectively evaluated and mapped using geodata analyses. Publicly available data from the Saxony geodatabase were used to analyze distances between local districts in Saxony and the private practices.

Results: The number of psychotherapists in private practice increased between 2014 and 2023, particularly in rural regions. The number of psychotherapists for adults increased from 761 to 1224. In 2023 all psychotherapeutic practices for adults were within 20 km of all districts in Saxony so that the provision of care improved with respect to the spatial coverage. In contrast, the availability of pediatric and adolescent psychotherapists and specialists in the child and adolescent sector as well as for adults has improved only slightly.

Discussion: The number of practices for psychotherapy has improved in urban and rural areas; however, there is a lack of data to reliably assess the coverage of needs. An analysis of the need for psychotherapeutic treatment is therefore urgently required.

Tic disorders are neurodevelopmental disorders characterized by involuntary motor and/or vocal expressions (tics). According to ICD-10 and ICD-11 classifications they are differentiated into transient (≤ 12 months) and chronic (> 12 months) tic disorders; the diagnosis of Tourette syndrome requires the presence of multiple motor tics and at least one vocal tic persisting for more than 1 year. Typical features of tics include onset in childhood, a premonitory urge, at least partial suppressibility and a rostrocaudal distribution. Differential diagnoses include other hyperkinetic neurological disorders as well as obsessive-compulsive symptoms, stereotypes and functional tic-like behaviors, the latter often presenting with a late, abrupt onset and predominantly complex expressions. Behavioral therapy is considered the first-line treatment for clinically relevant tics. Pharmacological treatment includes off-label use of dopamine antagonists, such as aripiprazole. Comorbidities are common and require targeted comanagement.

Background: In German addiction services around 40-50% of the men are fathers. Affected fathers often have difficulties in successfully realizing the fatherhood. The resulting demands can lead to changes in consumption; however, fatherhood is currently not regularly addressed as part of addiction treatment.

Material and methods: The aim of this narrative review is to describe existing associations between addictive disorders and fatherhood. A structured literature search conducted in March/April 2023, was used to identify qualitative and quantitative studies. German and English language articles published in 2013-2023 were included.

Results: A total of 20 studies were included in the review. In addition to consumption-related problems, fathers with addictive disorders are also influenced by father-specific factors. Those affected can often only live out their fatherhood insufficiently and not according to their own ideals; however, many fathers are motivated for change if they are aware of the negative effects.

Conclusion: The data point to interactions between addictive disorders and fatherhood. A joint treatment approach can be useful in order to meet existing needs. Not only the fathers can benefit from this but also their children.

Background: Affective disorders are associated with an enormous disease burden, necessitating research on the mechanisms of effective treatments.

Objectives: This article introduces the intervention projects of the transregional Collaborative Research Center 393 (CRC/TRR 393). By employing targeted interventions, we aim to induce modifiability in the key mechanisms underlying the trajectories of affective disorders studied in CRC/TRR 393: emotion regulation, expectation, social cognition, and (circadian) cognitive-behavioral rhythms.

Materials and methods: The longitudinal design of the CRC/TRR 393 study will examine four interventions targeting specific mechanisms in subgroups of the German Mental Health Cohort (GEMCO). GEMCO includes patients with a current or lifetime diagnosis of major depressive disorder (MDD), bipolar disorder (BD), and healthy control (HC) participants. Multilevel measurements of these targeted mechanisms will allow us to investigate their fine-grained modifiability and their effects on disease trajectories.

Results: The results will provide insights into how these mechanisms can be modified. Together with the CRC/TRR 393 mechanisms projects, we will examine the effects of key cognitive-emotional mechanisms on disease trajectories.

Conclusion: For the first time, the modifiability of four key mechanisms underlying the trajectories of affective disorders will be investigated both cross-sectionally and longitudinally.

Background: Extended reality (XR) encompasses various immersive technologies that enhance perception with virtual elements. Previous research has focused in particular on virtual reality-assisted exposure therapy but there are currently dynamic developments in terms of both content and structure of XR research for psychotherapy.

Methods: This narrative review describes content-related, technical and structural developments in the research of XR applications for psychotherapy, as identified by members of the Extended Reality for Psychotherapy network.

Results: The use of mixed reality technologies and artificial intelligence was mentioned as well as the development and testing of creative therapeutic concepts beyond the classical exposure paradigm. In addition, structural developments, such as the establishment of standardized processes, the professionalization of development, barriers to implementation in healthcare practice and regulatory aspects are outlined.

Discussion: The experts point to technical advances and emerging innovative concepts that would not be feasible in the current psychotherapy. Given the complex technology, which must simultaneously meet multiple regulatory requirements, broad-based interdisciplinary research is needed.

The recurrent and often unpredictable course of affective disorders poses a critical challenge for long-term patient care. The CRC/TRR 393 consortium has established an ambitious longitudinal study, the German Mental Health Cohort (GEMCO), to systematically investigate the trajectories of symptom recurrence and remission in affective disorders. This article provides an overview of the core structural projects of the CRC/TRR 393 consortium that underpin this effort. Project S02 orchestrates the GEMCO, recruiting 1500 participants (approximately 900 with major depressive disorder, 300 with bipolar disorder, 300 healthy controls) and conducting comprehensive phenotyping, neuroimaging, and biobanking at baseline and follow-up time points. Project S01 provides an innovative mobile health infrastructure for continuous monitoring of patients' mood, behavior, and environment in real time over a 2-year period, enabling detection of early warning signs ("inflection signals") of mood episodes. Project INF implements a centralized information infrastructure, ensuring high-quality data capture, multisite data integration, and open-science data sharing. Project S03 serves as the advanced data analysis hub, developing machine learning models to predict individual illness trajectories and outcomes from the rich multimodal data. A research training group (RTG) provides funding and infrastructure for early-career scientists. Together, these structural projects establish a state-of-the-art framework for studying affective disorder trajectories, with the ultimate goal of identifying predictors and mechanisms of relapse and remission, and paving the way toward mechanism-based clinical interventions.

Background: Value-based healthcare (VBHC) is a concept in health economics that aims to improve patient care through needs-oriented treatment approaches while considering the costs incurred. "Value" describes the ratio of patient-centered outcome and experience data to the costs incurred.

Objective: To analyze and optimize the workflows of the Outpatient Memory Clinic of the ZI Mannheim according to VBHC criteria. The aim of the study was to improve the quality of care from the patient's perspective, to measure the changes in benefits for all involved parties and simultaneously to evaluate the costs and revenues of the diagnostic process.

Methods: The initial diagnostic process was analyzed in 25 dyads (patient + caregiver) using standardized (State-Trait Anxiety Inventory (STAI), Patient Assessment of Chronic Illness Care (PACIC), Euroquol visual analogue scale (EQ-VAS)) and process-oriented questionnaires. After staff training, a modified diagnostic process (VBHC-M) was implemented in a pilot study. This process was then evaluated in a second survey of 17 dyads and 8 additional patients using the same questionnaires. The results from both surveys were compared using t‑tests or Mann-Whitney U tests. A cost and revenue analysis (CRA) was conducted using annual data.

Results: The quality of care (PACIC) for patients (p < 0.001) and caregivers (p = 0.004) improved following VBHC‑M, as did patient satisfaction and expectations (process-oriented questionnaires). The CRA showed that VBHC‑M resulted in a financial disadvantage for the care provider.

Conclusion: The workflows of the outpatient memory clinic could be successfully optimized in the sense of patient-centered care, leading to an increased number of patients treated, higher patient and caregiver satisfaction and cost savings. This shows that VBHC can be implemented in outpatient memory clinics; however, the accelerated diagnostic process is reimbursed at a lower rate under the current flat-rate quarterly payment system, highlighting the need for adjustments to reimbursement models.

Effective treatment of affective disorders (AD) requires a deep understanding of the underlying neurobiological mechanisms. However, in machine-learning-based analyses, cross-sectional studies have failed to identify robust individual-level biomarkers. Research Domain A of CRC/TRR393 addresses this gap by implementing longitudinal, multimodal studies using real-time mobile assessments. Central to this effort is the identification of "inflection signals"-clinically meaningful symptom changes marking transitions from euthymia to depressive or (hypo)manic episodes. These critical windows are captured through digital phenotyping and ecological momentary assessments and followed up by in-depth neurobiological profiling. Six projects examine the dynamic interplay of behavioral, cognitive-emotional, molecular, immune, and neural mechanisms during these transitions. Project A01 validates early-warning models using digital phenotypes and machine learning. Project A02 maps structural and functional brain changes in relation to disease course and risk factors. Project A03 investigates the role of microglial immune activation in recurrent depression. Project A04 investigates neurobiological alterations after inflection signals using intensive, multimodal data acquisition conducted both in laboratory settings and in the participants' personal environments. Project A05 adds molecular and immunological profiling and integrates findings from human and animal data. Project A06 studies trajectories from bipolar at-risk states to full-blown illness. Together, these projects form the empirical foundation for mechanism-based interventions (Domain C) and theoretical modeling of symptom trajectories (Domain B).

Background: Memory clinics in Germany are facing major challenges due to increasing numbers of patients and the first available disease-modifying treatments for Alzheimer's disease. Capacities for counselling, biomarker-based diagnostics, drug administration and follow-up examinations must be achieved, which creates the need for modified workflows. Value-based healthcare (VBHC) aims at optimizing the value for patients (outcome in relation to costs) and can serve as a framework for a patient-oriented increase in efficacy.

Objective: This project applied approaches of VBHC to analyze and improve the diagnostic processes in our memory clinic in order to achieve a better value for patients and care partners with a more efficient use of existing resources.

Methods: In a first survey among memory clinic patients and relatives the essential aspects in relation to VBHC were collated and based on the results the existing workflow processes were modified. These modifications were evaluated by a second survey and analysis particularly of process-oriented aspects.

Results: The first survey revealed a general satisfaction with the presentation in the memory clinic. The main point of criticism was the duration of the diagnostic process. After the modification the duration and extent of the diagnostics could be reduced. The second evaluation showed improved patient and care partner satisfaction. The respondents considered the modified trajectories to be better and resources were conserved.

Conclusion: In our memory clinic an improvement in the sense of VBHC could be achieved through an increased satisfaction with the treatment (outcome) and reduced personnel binding times (costs). This approach can serve as a model for other memory clinics for the development of a more efficient and patient-centered care.