General Information

Anxiety can be an unpleasant feeling but it is an instinctive behavioral response and essential to survival. Anxiety disorders are different from anxiety. Anxiety disorders are more severe, last longer, have a negative impact on a person's work or private life and are associated with a more negative and one-sided view of the perceived threat. Most common anxiety disorders are: specific phobias (e.g. fear of spiders, insects, mice, snakes, heights, blood, injections, storms, driving, flying, elevators or enclosed spaces), social anxiety disorder (social phobia), generalized anxiety disorder (GAD), agoraphobia, panic disorder, post-traumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD). It is common that people have some features of several anxiety disorders. A high level of anxiety over long time will often lead to depression. People with anxiety disorders frequently use substances as a form of self-medication in an attempt to cope. This can lead to alcohol and substance use problems.

A wide range of effective treatments for anxiety disorders exists. There are various psychological therapies that can be enhanced by prescribed medication. Also relaxation training has been found to be an effective complementary therapy.

Depression is different from feeling sad since people with sadness manage to cope and soon recover without treatment. A major depressive disorder lasts for at least two weeks and affects a person's ability to carry out their work and usual daily activities and to have satisfying personal relationships. Symptoms of depression are: depressed mood, loss of pleasure and interest in activities that used to be enjoyable, lack of energy and tiredness, feelings of worthlessness or inappropriate guilt, diminished ability to think or concentrate, indecisiveness, insomnia or hypersomnia, decrease or increase in appetite, restlessness or slowing down or recurrent thoughts of death and suicide. Not every person shows all of these symptoms.

Various psychological therapies are effective in treating depression. For moderate and severe depression, prescribed antidepressant medication can be helpful in addition to psychotherapy or preceding the psychotherapy. For mild depression, antidepressants may not always be warranted. There's evidence for many complementary therapies to be helpful for depression: exercise, keeping a mood diary, spirituality, positive social contacts, self-help support groups, light therapy or herbal remedies.

Alcohol or substance use becomes a problem when the consumption is at levels that are associated with short-term or long-term harm. The most widely misused substance in Switzerland is alcohol. Other misused substances are nicotine, cannabis, ecstasy, pharmaceutical drugs (for non-medical purposes), cocaine, amphetamines, hallucinogens and opioid drugs (e.g. heroin). Severe effects can be caused by alcohol misuse (e.g. car accidents, increased aggressive behaviors, higher risk of attempting suicide, alcohol poisoning, seizures and delirium from alcohol withdrawal) and other drugs (e.g. overdose, overheathing, dehydration, illegal offences).

Local drug and counselling centers provide help to find an appropriate treatment. Treatments aim at overcoming any physiological or psychological dependence (if the drug is used to cope with anxiety or depression) and unhelpful habits. Effective treatments are withdrawal management (controlled use, reduction in usage or even abstinence) under professional supervision (family doctor, clinic) in combination with lifestyle and behavioral changes, psychological treatments and medication and substitution.

People with bipolar disorder can experience periods with depression, periods with mania and long periods of normal mood in between. The periods of depression are typically more common than the periods of mania and the lengths of these periods varies from person to person from days to even years. For the symptoms of depression see depressive disorders. Symptoms of mania are opposite to depression and include elevated mood, overconfidence, being full of energy, talkative, full of ideas, have less need for sleep or taking more risks as usual. This can lead to difficult situations e.g. spending too much money, becoming angry and aggressive, legal trouble or risky sexual behavior. People with severe bipolar disorder may develop psychotic symptoms.

Treatments that help people with bipolar disorder are two types psychological therapies, prescribed medication (including mood stabilizers, certain anticonvulsants and certain antipsychotics), psychoeducation (providing information to the person about the disorder and its treatment and how to manage its effects on life) as well as family therapy (providing information to the family how to support the person and avoid negative interactions that could trigger relapses).

Reasons and causes for eating disorders are varied and complex. Eating disorders often co-exist with other mental health issues such as anxiety, depression, obsessive-compulsive disorders, personality disorders or substance misuse. Women are more frequently affected. Anorexia nervosa is associated with being seriously underweight, although this is not seen as a problem by the person affected. Bulimia nervosa is associated with the attempt to lose weight and periods of uncontrolled overeating, leading to 'normal' weight or somewhat over- or underweight. Binge eating disorder is associated with eating a lot of food in a short period of time but not sustained weight-control behavior. Eating disorders can cause a wide range of physical and psychological health problems including increased risk of self-harm and suicide.

Treatment is often long-term and intensive. One therapy known to work for adolescents with anorexia is family therapy. Cognitive behavioral therapy is the best treatment for bulimia and binge eating disorder (self-help groups, self-help books and internet therapy based on cognitive behavioral therapy have been shown to be helpful). Exercise should only be done with professional advice and monitoring.

Psychosis is usually a temporary condition in which a person has lost, at least some, contact with reality. Delusions and hallucinations are typical symptoms of psychosis. Disorders in which a person can experience psychosis include schizophrenia, psychotic depression, bipolar disorder (psychotic depression or psychotic mania), schizoaffective disorder and drug-induced psychosis. People usually experience psychosis in episodes, which vary in length from person to person. About one third of people experience psychosis have only one episode during lifetime, another third has multiple episodes, recovering (full or partial) between episodes and the final third develops a chronic disorder. Men are more frequently affected.

Treatments for psychosis and schizophrenia aim at improving quality of life. Helpful treatments are psychological treatments usually in combination with antipsychotic medication (considerable side effects of some antipsychotic medication make monitoring of physical health necessary), educating the person and their families how to manage the disorder, social skill training and regular health checks.

A fraction of people experiencing a traumatic situation such as (but not limited to) being involved in a car crash, being raped or sexually assaulted, being abused , harassed or bullied, experiencing violence, or seeing other people hurt or killed or surviving a natural disaster develop a post-traumatic stress disorder (PTSD). Being exposed to multiple traumatic situations such as childhood abuse, neglect or abandonment, ongoing domestic violence or abuse, repeatedly witnessing violence or abuse, being forced or manipulated into prostitution, torture, kidnapping or slavery or being a prisoner of war can lead to a complex PTSD (c-PTSD). Common symptoms of PTSD are reliving aspects of what happened, alertness or feeling on edge, avoiding feelings or memories and having difficult beliefs or feelings. Some symptoms of c-PTSD include those of PTSD and also difficulty controlling your emotions, feeling very angry or distrustful towards the world, constant feelings of emptiness or hopelessness, feeling as if you are permanently damaged or worthless, feeling as if you are completely different to other people, feeling like nobody can understand what happened to you, avoiding friendships and relationships, or finding them very difficult and often experiencing dissociative symptoms such as depersonalisation or derealisation.

The two talking treatments trauma focused cognitive behavioural therapy (TF-CBT) and eye movement desensitisation and reprocessing are recommended for PTSD. TF-CBT is also recommended for children with c-PTSD. Treatment of c-PTSD is individual, in collaboration with the patient, multicomponent and should include a trauma focused component and psychoeducation about c-PTSD. Medication is usually not prescribed but might be prescribed for certain symptoms.