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Background: Although affective disorders are a major driver of disability worldwide, there is a lack of understanding of the mechanisms and modulating factors involved in the long-term disease trajectories.

Objectives: Our goal is to determine key cognitive-emotional mechanisms in the domains of emotion regulation, expectation, social cognition, and cognitive-behavioral rhythms and their neurobiological correlates in the progression of affective disorders, including recurrences and remissions, chronicity, and functional decline.

Materials and methods: In CRC/TRR 393, we will pursue a multi-level investigation of these four domains. Within the German Mental Health Cohort (GEMCO), these mechanisms and their influence on disease trajectories will be investigated longitudinally. Parallelized human and animal projects will enable an in-depth characterization of their neurobiological correlates.

Results: By leveraging recent advancement in the modeling of complex, dynamic systems and machine learning techniques, we will be able to integrate human and animal data on the key cognitive-emotional mechanisms and their interplay with stressors and other modifying factors across disease trajectories.

Conclusion: Gaining a deeper understanding of the cognitive-emotional mechanisms in the progression of affective disorders will help to predict symptom changes and course of illness as well as to identify key targets of intervention.

Background: People with severe mental disorders often need multiprofessional treatment and support, even between acute phases of illness. During the integration support they repeatedly switch between inpatient acute care and outpatient community psychiatric care.

Objective: What is integration support? What tasks in the care of severely mentally ill people are fulfilled by integration assistance? How can cooperation between acute psychiatry and integration support be successful?

Material and method: Selective literature search.

Results: The integration support according to the Social Security Code IX (SGB IX) serves to support social participation. This need is often present in the group of severely mentally ill people. Integration support services can be used flexibly and needs oriented. The cross-sectoral, person-centered treatment of this patient group requires close coordination between clinics, outpatient therapists and integration support, for example by case conferences and case management.

Conclusion: Clinics, outpatient practitioners and providers of integration support should closely cooperate with each other to provide social inclusion for severe mentally ill patients.

This article describes the development and criticism of community psychiatry in Germany since the 1975 Inquiry Commission on Psychiatry as well as its precursors and reference points. While the inquiry called for fundamental reforms such as the establishment of community-based care structures, the concrete content and structural guidelines remained vague. This lack of clarity meant that community psychiatry was characterized less by central reforms than by a large number of regional model projects. With a view to the historical context, this project orientation is interpreted as an expression of a shift in focus since the 1980s towards self-help, civil society actors and the flexibilization of the social state. Although projectification has led to diversification and professionalization, it has also resulted in uncertainty, lack of sustainability and fragmentation of care. Community psychiatry is thus seen as a mirror of social and political change.

Background: Young people in mental health crises have severely limited access to clinical care and show the lowest adherence to conventional clinical services. Low-threshold and integrated services (integrated youth mental health services, IYMHS) are recommended to overcome these barriers and provide early detection, early intervention and psychosocial care appropriate for young people.

Objective: The aim is to provide an overview of low-threshold IYMHS globally and in Germany and to report on international experiences with these services and evidence of their effectiveness.

Methods: The narrative review is based on research conducted in PubMed, including the use of published reviews.

Results: International developments show that IYMHS have become established as innovative models of care for young people in mental health crises. Australia is seen as a pioneer with its nationwide network of headspace centers. In Germany, soulspace is the first model project and another, ancora, is in the pipeline. Evaluations to date show that many young people who would not otherwise have sought help use these integrated services and predominantly experience symptomatic and functional improvements.

Conclusion: International experiences to date and pilot projects in Germany have demonstrated the potential of IYMHS to provide low-threshold support at an early disease stage to young people with first symptoms of mental health. For Germany, expanding an integrated, cross-sectoral care structure is recommended through pooling resources from statutory health insurances and public funding.

Background: Numerous studies have shown a high incidence and increase in stress-related symptoms and depression-like complaints among students. During teaching on mental disorders at our medical faculty, students repeatedly reported emotionally stressful situations and expressed a desire for support services. The aim of the present study was to objectify the level of stress and the need for such support services.

Material and methods: A total of 118 students in the 9th semester (winter semester 2022/2023) were surveyed using a questionnaire on their emotional stress. The online questionnaire was conducted via LimeSurvey (LimeSurvey GmbH, Hamburg, Germany) and contained a total of 18 items formulated as statements as well as other items. The students rated the individual items on 11-point numerical scales with external anchor ratings.

Results: The respondents rated their own stress as increased compared to other modules, particularly for the subject of psychiatry (> 5 out of 10). Bedside teaching was estimated as being the most stressful, followed by seminars and lectures (all pairwise comparisons p < 0.001). The contents on depression predominantly caused the most stress. Approximately half of the students would like to be offered support services and most frequently a consultation session (78.0%) and defined contact persons (70.7%).

Conclusion: The emotional stress of students in the context of teaching on mental disorders is particularly high in psychiatry and higher with increasing patient contact; offers of support services are needed. Teachers should be sensitized to this and create offers such as open consultation sessions and the provision of defined contact persons.

Background: To overcome fragmented care provision in Germany, flexible, integrated psychiatric care (FIT) model projects according to § 64b of the German Social Code Book (SGB) V were implemented.

Objectives: The results of the prospective cross-model, controlled, multiperspective/multimethod study PsychCare are presented and discussed along with data from statutory health insurance (SHI)-based research.

Materials and methods: PsychCare applied a multi- and mixed-method design. Primary data were acquired in 18 psychiatric hospitals (n = 10 FIT; n = 8 matched treatment as usual-TAU) at study start (M-I) and 15 months later (M-II). Main outcomes were treatment satisfaction and health-related quality of life. Secondary outcomes included recovery, clinical decision-making, symptom severity, healthcare utilization and costs, needs and experiences with care, and caregiver burden. Participatory process evaluation assessed process-, structure-, and experience-related components.

Results: Patients in FIT (n = 595) had significantly higher treatment satisfaction (ZUF-8: 26.3 ± 4.36 vs. 24.9 ± 4.70; p < 0.001) and recovery (RAS‑R total: 134 ± 35.8 vs. 119 ± 54.3; p < 0.001) at M‑I compared to TAU patients (n = 555), despite comparable symptom severity. About 50% of patients reported high satisfaction with clinical decision-making (p > 0.05); FIT caregivers were numerically more satisfied. Direct medical costs were significantly lower in FIT both at M‑I and M‑II. Type of care was associated with the degree of implementation of FIT components. Linking primary and SHI data was feasible.

Conclusion: PsychCare showed that FIT was superior in cross-sectional treatment satisfaction, recovery, and caregiver satisfaction with suggested cost-effectiveness. Long-term FIT success compared to standard care needs further assessment.