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The great majority of suicides and suicide attempts are related to mental illness. Special risk has been attributed to depression, psychosis, substance use, personality, and trauma-related disorders. Many affected persons seek medical attention prior to taking action. Primary care therefor plays an outstanding role in suicide prevention. Doctors should pay attention to potential risk constellations and actively address the issue. This paper presents possibly helpful models and instruments for everyday use. Most importantly, however, professionals’ empathy and time are required as well as appropriate decisions concerning a referral to a psychiatrist or psychiatric inpatient treatment.

In the last decade the indication of antipsychotics has been expanded from the treatment of psychoses to the treatment of impulsive-aggressive behaviors in mentally retarded children and adolescents with conduct disorder or autism spectrum disorders. As a consequence the use of antipsychotics in children and adolescents has increased worldwide. This increase of prescriptions is under critical discussion. In this paper the indication and the potential side-effects of antipsychotics in children and adolescents are described. The risks of antipsychotic medication are contrasted with the potential benefits to arrive at rational treatment recommendations.

Objective: This paper describes socio-demographic, clinical, and treatment-related parameters of psychiatric patients who were hospitalized for at least two months on an acute psychiatric ward compared to patients with a shorter inpatient treatment episode. Furthermore, it is evaluated how frequent these long-staying patients are awaiting a room in a sheltered housing facility., Methods: We investigated the longest inpatient treatment period of all patients aged between 18 and 65 years on an acute ward of the Psychiatric University Hospital Zurich (n = 3,928) using the basic documentation of the years 2006 to 2010., Results: 20 % of all patients on acute wards had a stay of more than 60 days. Socio-demographic and clinical characteristics are similar to those of "heavy users" of mental health services. Social work is involved more frequently, and placement in sheltered housing facilities is intended in one third of those patients., Conclusions: A substantial part of the patients who stay at least once longer than two months on an acute ward are discharged to sheltered housing. Besides severity of illness it is likely that lack of availability of an adequate housing option contributes to length of stay. Intensified cooperation of the psychiatric clinic with sheltered housing facilities as well as alternative options for those in need of assisted housing and mental health care might help to reduce their extensive usage of inpatient treatment capacities. Interventions and services have to be adapted to local conditions., (© Georg Thieme Verlag KG Stuttgart · New York.)

Given the great prevalence of mood disorders in early motherhood, the danger of chronic, particularly depressive mood disorders and the negative long-term effects on the socio-emotional development of the child requires specific and individual treatment. Midwives could serve as mediators between women patients and health care professionals. Therefore the project "Early detection and care of peripartum mood disorders, increasing options for reaching affected women" was initiated by the "German chapter of the International Marce Society" in cooperation with midwives. This paper presents results of the preliminary investigation. 111 midwives were interviewed in 12 centres in Germany, Switzerland and Austria regarding their experience and knowledge of psychic disturbances in early motherhood. Psychic disturbances are seen as an essential issue by the participating midwives. In their estimation 39 % of the pregnant women they cared for are exceptionally psychically burdened. In approximately 43 % of the cases they believe that the physical complaints of pregnant women have a psychic background. In addition to "classic" mood complaints, midwives often perceive dysfunctions in the relationship between the mother and her child and that with her partner in the context of psychic disturbances during the peripartum period. In the diagnosis of psychic disturbances in early motherhood, attention should be paid to possible dysfunctional interactions between the mother and her child and that with her partner. Successful treatment of women with psychic disturbances in early motherhood requires cooperation between midwives, obstetricians and other health professionals.

Aim: The paper is aimed at investigating what the actual topics of social-psychiatric research in German speaking countries are., Method: German and international journals covering psychiatry and adjacent disciplines were screened for articles dealing with social-psychiatric topics. All in all, 426 relevant articles were identified and subjected to a content analysis., Result: Almost one third of all articles was dealing with research on mental health services. Another research area that was strongly represented was epidemiology. By contrast, articles devoted to the study of psycho-social causes of mental disorders and psycho-social determinants of its course were rather rare., Discussion: Possible reasons for the observed trends in social-psychiatric research are discussed. Potential risks for social psychiatry resulting from a too one-sided emphasis on health service research are pointed out.

Objective: The present paper describes the type and prevalence of co-morbid psychiatric disorders in a group of opioid dependent addicts., Methods: In 17 Swiss centres for heroin-assisted treatment 85 opiate addicts were assessed at entry using the SKID interview., Results: Lifetime prevalence of co-morbid Axis I or Axis II disorders was 86 %. Most frequently patients were diagnosed with a personality disorder (58 %). Second frequently were mood disorders with a prevalence of 55 %, followed by anxiety disorders with a prevalence of 26 %., Conclusions: The high prevalence of co-morbid psychiatric disorders indicate the urgent necessity to further develop and adapt health services for opioid addicts.

This paper examines the drugs used in Ludwig Binswanger's private sanatorium "Bellevue" in Kreuzlingen on the Lake of Constance between 1857 and 1870. The available patient records have revealed the administrated drugs, prescriptions have been transcribed, and the guidelines for the use of the drugs have been reconstructed by means of the literature. It becomes obvious that the armamentarium of drugs prescribed was limited and can be connected with the treatment of physical ailments which the "somatist" Binswanger considered as the main cause for psychic disorders. Binswanger was very careful when prescribing one of the few available "psychotropic" drugs like opium and morphine. This restraint in using drugs is in contrast with many recommendations and habits of Binswanger's contemporaries and shows that he put higher emphasis on the effectiveness of the "therapeutic milieu" than on a pharmacotherapy of insanity.

The paper describes the development of an epidemiologically oriented community mental health service (the external psychiatric services of the Canton of Baselland). Because helpful intervention is intended not only to those labelled as patients as is the case in outpatient clinics, the main emphasis is on outreach toward the prospective endangered population, those suffering from chronic mental disease or those in danger of relapses. To this end it is of utmost importance to create networks of collaboration with all other social helping institutions as well as with family physicians, psychiatrists, community officials, ministers, public health nurses as well as with voluntary helpers. The creation of transitional and rehabilitative institutions for sheltered living, rehabilitation for work and for leisure time structuring can take place through the service itself or in collaboration with existing voluntary or charitable organizations. The described service has, on account of extremely restricted personnel, chosen to seek collaboration with a great number of community organizations. The offices of the two ambulatory services (there are two for two somewhat unequal parts of the Canton), function therefore, next to their treatment function, also as centers of coordination for rehabilitative efforts. Coordination of social and health services in the community has been realized in a number of towns. A decentralized but relatively fine-meshed network of caring for the psychically ill or handicapped could be established in the relatively short time of eight years. Network formation is recommended as an epidemiologic technique for the treatment and care of a population at risk, this especially in view of prophylaxis of relapses of severe psychiatric disease.

This paper presents results of a study which was done as part of an investigation on predictor variables for new long-stay patients. Using easily accessible data, e.g. age, sex, diagnosis, etc., 145 new long-stay patients of the Psychiatric Department of Berne University (PUK Bern) admitted from 1979 to 1982 were compared with all in-patients and 396 old long-stay patients of the same clinic, as well as with British and German case-register populations. A total of 3.1% of all admissions in this four-year-period received in-patient treatment for more than one year; this proportion is similar to those reported from British and German case-registers. Older patients tend to have more long stays in hospitalizations; only 25% in the PUK new long-stay population were aged 65 and over. The sex ratio men: women was 1:1, whereas there are twice as many women as men among new long-stay patients in Great Britain. Looking at marital status we found, as could be expected, only very few married people (15%), compared with 62% unmarried and 23% widowed or divorced. The diagnostic composition showed that organic brain syndromes, schizophrenia, personality disorders, and mental retardation were over-represented in the new long-stay population. The diagnostic comparison between new and old long-stay patients showed substantial differences which proved to be congruent with the results of other investigators.

In the last decades more and more community psychiatric services have been established. When such services work in close cooperation with a general hospital new and interesting possibilities of interventions are possible. Closeness with hospital physicians can improve the image of psychiatry among physicians as well as the general population. This paper reports about experiences made in a newly established psychiatric service based in a general hospital of 300 beds, focussing on the possible interventions in acute psychiatric crises.

The paper submitted deals with the shrinking number of in-patients in psychiatric institutions and proves that this downward trend is not to be explained merely by the introduction of psychotropic drugs.--The method of calculation and the term "average duration of stay" are critically discussed, with reference to other possible parameters as indicators of psychiatric in-patient facilities.--It is shown, in the light of recent and controlled studies, that short hospitalization can be at least as effective and successful as a conventional hospital treatment program, and that a shorter stay in hospital does not inevitably imply an increased risk of readmittance.--A comparison between the Psychiatrische Universitätsklinik Bern (PUK) and all psychiatric hospitals in Switzerland shows in 1980 a 50% higher rate of admissions per hospital bed, a 20% shorter duration of stay, and the extremely high average rate of 98% of beds occupied, that is approximately 10% more than the average number of beds occupied in the other clinics referred to. In spite of the comparatively short duration of stay in the Psychiatrische Universitätsklinik Bern, that is 27 days (median), a further cut in length of stay seems feasible, without provoking an increase of the low rate of 21% of readmissions per annum.

This paper's purpose is to define the immigrant's status and give evidence of psycho-social problems of the uprooted in a survey of hungarian and czech refugees. It is evident that morbidity of immigrant populations is generally increased. Also, certain nosological states are prevalent. Most of all, we have investigated delusions of reference in a culturally alien environment. Moreover, some psychoanalytical and sociological aspects pertaining to the immigrant's status (identity, assimilation, overadaptation, feelings of discrimination, socio-cultural hierarchy) are discussed. Ultimately, practical approaches to the psychological misery of immigrants are suggested.