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BACKGROUND: In line with previous findings, in a recent randomized controlled trial (RCT), we found that home treatment (HT) for acute mental health care can reduce (substitute) hospital use among severely ill patients in crises. This study examined whether the findings of the RCT generalize to HT services provided under routine care conditions. METHODS: We compared patients who received HT during the RCT study phase with patients who received the same HT service after it had become part of routine mental health services in the same catchment area. Sociodemographic and clinical characteristics as well as service use (HT and hospital bed days) were compared between the RCT and the subsequent routine care study period. RESULTS: Compared to patients who received HT during the RCT, routine care HT patients were more often living with others, less often admitted compulsorily, more often diagnosed with anxiety and stress-related disorders (ICD-10 F4) and less often diagnosed with schizophrenia spectrum disorders (F2). When compared to patients who were exclusively treated on hospital wards, involvement of the HT team in patients' care was associated with a clear-cut reduction of hospital bed days both during the RCT and under routine care conditions. However, unlike during the RCT study period, involvement of HT was associated with longer overall treatment episodes (inpatient + HT days) under routine care conditions. CONCLUSIONS: HT seems to reduce the use of hospital bed days even under routine care conditions but is at risk of producing longer overall acute treatment episodes.

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Home treatment has been proposed as an alternative to acute psychiatric inpatient treatment. Health insurance systems in Germany and in Switzerland hinder the nationwide implementation of home treatment teams into mental health systems, although the German S3 guidelines for psychosocial treatments of severe mental illnesses recommend provision of acute care at home. Evidence for home treatment is positive, yet there are only few up-to-date studies from Europe and differential indication criteria are lacking. The aim of home treatment is to reduce inpatient bed-days by nonadmission or early discharge. Home treatment teams are mobile, interdisciplinary, and provide 24 h services. The average treatment length in home treatment should not exceed the duration of the inpatient treatment. The home treatment team usually takes the responsibility for the gatekeeping for inpatient treatment. Future research should focus on precise definitions of the structures and interventions of home treatment teams. Home treatment for severely mental ill patients should be distinguished from assertive community treatment and case management, which offer continuing rather than acute crises care.

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This study aimed to examine the association between the availability of firearms at home, and the proportion of firearm suicides in Switzerland in an ecological analysis. The data series were analysed by canton and yielded a fairly high correlation (Spearman's rho=0.60). Thus, the association holds also at a sub-national level.

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We examined the change in Swiss suicide rates since 1969, breaking down the rates according to the method used. The descriptive analyses of the main suicide methods are presented. The suicide rates reached a peak in the late 1970s/early 1980s and declined in more recent years. Firearm suicides and suicides by falls were the exception and sustained their upwards trend until the 1990s. Suicide by vehicle exhaust asphyxiation showed a rapid decline following the introduction of catalytic converters in motor vehicles. No substantial method substitution was observed. Suicide by poisoning declined in the 1990s but rose again following an increase in assisted suicide in somatically incurable patients. Suicide is too often regarded as a homogeneous phenomenon. With regard to the method they choose, suicide victims are a heterogeneous population and it is evident that different suicide methods are chosen by different people. A better understanding of the varying patterns of change over time in the different suicide methods used may lead to differentiated preventive strategies.

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OBJECTIVE: The aim of the study was to assess the frequency of co-morbid post-traumatic stress disorders (PTSD) in women with eating disorders (ED). METHOD: 277 women aged 17 to 50 with a current DSM-IV ED were included. 84 were diagnosed with anorexia nervosa (AN), 152 with bulimia nervosa (BN) and 41 with ED not otherwise specified (EDNOS). Structured Clinical Interviews (SCID-I and SCID-II) were performed. RESULTS: Sixty-eight participants (24.5%) reported unwanted sexual experiences (USE). Fifty-two participants (18.8%) reported some form of childhood sexual abuse (CSA). Four participants (1.4%) met the criteria for PTSD according to the Diagnostic and Statistical Manual-IV (DSM-IV). Participants with a history of USE did not differ from those without USE with regard to ED diagnosis, but were diagnosed more often with any Axis I or Axis II disorder. CONCLUSIONS: The prevalence of PTSD in this sample of women with ED was low (1.4%), despite a USE rate of 24.5%.

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OBJECTIVE: Despite being recognized as an important prognostic factor for the outcome in gender identity disorder (GID), psychiatric comorbidity has rarely been assessed by means of standardized diagnostic instruments. The aim of this study was to assess current and lifetime psychiatric comorbidity in patients with GID. METHODS: A cross-sectional sample of 31 patients who were treated for GID was assessed by the structured clinical interview for Axis I and II (SCID-I/II) and the Hospital Anxiety and Depression Scale (HADS). RESULTS: Twenty-nine percent of the patients had no current or lifetime Axis I disorder; 39% fulfilled the criteria for current and 71% for current and/or lifetime Axis I diagnosis. Forty-two percent of the patients were diagnosed with one or more personality disorders. CONCLUSIONS: Lifetime psychiatric comorbidity in GID patients is high, and this should be taken into account in the assessment and treatment planning of GID patients.

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Annually, approximately 1300 people commit suicide in Switzerland. Whilst general practitioners play a crucial role in the prevention of suicide, suicidal patients are a huge burden on physicians. The risk factors for suicide are well known but a comprehensive assessment of the suicide risk calls for an evaluation of the individual resources. Most at risk are those who have previously attempted suicide; the risk of repetition remains elevated for years. Suicide in itself is not a disease but it is closely related to mental disorders. A critical issue in suicide prevention is the recognition and treatment of underlying disorders. Patients often refuse further therapy after an attempted suicide, probably due to communication problems between patients and mental health professionals. It will be demonstrated how it is nevertheless possible to establish a therapeutic alliance which would prove beneficial in a future crisis.

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In a retrospective study, 33 transsexual patients, 22 male-to-female transsexual (MF-TS), and 11 female-to-male transsexuals (FM-TS), were interviewed 53-121 months after their first referral to the psychiatric department of a university hospital. Social integration proved to be satisfactory and relatively stable. Twenty-five patients had gone through surgical sex reassignment, while 29 were currently undergoing hormonal treatment. Regarding the course of treatment, the FM-TS were a more homogeneous group than the MF-TS group. Overall, physical and psychosocial well-being was satisfactory. Psychometric measures yielded remarkably normal values, with some pathological findings regarding personality traits. In the majority of patients, self- and observer-rating appraisals of gender-specific physical appearance were equally positive. The results suggest a three-step procedure for the treatment of transsexual patients, as is practiced in other centers within German speaking continental Europe.

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Delirium is a common psychiatric complication in somatically ill in-patients and is associated with increased morbidity and mortality, longer lengths of stay and higher cost of treatment. It remains often unrecognized and thus inadequately treated. The main risk factors, differential diagnosis, primary and secondary prevention, non-pharmacological interventions and pharmacological treatment are discussed. For the treatment of the non alcohol associated delirium, haloperidol remains the treatment of choice, whereas for the treatment of delirium related to alcohol withdrawal benzodiazepines and clomethiazole are recommended. Other treatment strategies, especially the use of newer atypical antipsychotic medications are outlined.

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Transsexualism, a gender identity disorder, is manifested by a strong and persistent cross-gender identification and the desire to adapt the body to the preferred sex by hormonal and surgical sex reassignment. The etiology of gender identity disorder is not known. Treatment takes place gradually in phases in a interdisciplinary setting (psychiatry, endocrinology, gynecology and surgery). In Switzerland, in contrast to other European countries, there is no special legislation to regulate the change of the name and personal status.

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