The prevalence rates are comparable and relatively stable between countries and across survey instruments, and do not differ from earlier reviews. The regular epidemiological monitoring of excessive gambling remains a major Public Health issue although the distinction between pathological and problem gambling is not appropriate for epidemiological research. Further studies are needed with respect to concomitant lifestyle characteristics.

Since the late eighties, Switzerland, like most other European countries has experienced an aggravation of problems associated with the use of illegal drugs. To cite a few of the alarming problems we might mention the poor health status of drug addicts, and the risk of the spread of hiv and other infections to the general population, as well as the dramatic upsurge of drug-related death over the last ten years (figure 1). The growing misery of intravenous drug users, criminality and violence are of major concern to the Swiss population (figure 2). This gloomy picture needs to be put into perspective, however. The use of illegal drugs is not by any means the most alarming dependence problem in Switzerland. As becomes apparent from figure 3, it is surpassed by alcohol consumption and the use of legal drugs. The habit of intravenous drug use which constitutes a major health risk has remained relatively stable according to various surveys of the general population (figure 4). Hiv infections have decreased among the intravenous drug users (see figure 5).We might conclude from these findings that: a the situation of heavily dependent intravenous drug users has markedly deteriorated; b poor health, death, violence and crime are threats to drug users and are of major concern to the general population; c dependent illegal drug use is confined to a relatively small section of the adult population; d intravenous illegal drug use does seem to have remained stable; e the widespread needle-exchange programmes, largely financed by the Swiss Federal Office of Public Health, were probably relatively successful in containing hiv infection; f measures taken by the Swiss Federal Office of Public Health do affect the behaviour of intravenous drug users in significant ways; g provided the appropriate measures are taken, intravenous drug users are able to behave in a responsible way and should not be

Background: Obsessive compulsive disorder (OCD) is a highly heritable neuropsychiatric disorder. Attempts to elucidate contributing genes have met with limited success. Intermediate markers of brain

The aim of this study is to test the hypothesis that coadjuvant treatment with SSRI and topiramate would improve the outcome of patients with comorbid OCD and impulsive behaviour disorders. Methods: We will describe two clinical cases admitted to our Psychiatric Hospitalization Unit. Case 1 is a 39 years old female diagnosed with OCD, borderline personality disorder and alcohol dependence and case 2 is a 38 years old male with OCD, mixed personality disorder and cocaine abuse. Results: Treatment with topiramate (range dosage: 250-400 mg/ daily) as well as SSRI (paroxetine 40 mg/daily-case 1; sertraline 200 mg/daily-case 2) improved affective instability and impulsive symptoms in both patients. Topiramate was well tolerated without important side effects. Conclusions: Topiramate could be an interesting alternative in the coadjuvant treatment of OCD with impulsive features.

Background and Aim:The present study addresses the empirical basis for alerting health professionals to potential risk factors for excessive gambling. On the basis of international and Swiss literature on gambling, an explanatory model for the development of gambling problems is developed.Hypotheses:This work is based on the hypothesis that the prediction rule for excessive gambling, based on a sample of the general population and for different types of frequent gambling preferences, differs from the prediction rule for disordered gambling in patients, seeking psychiatric treatment. The goal of this study is, therefore, to contribute to an early identification of disordered gambling behaviour in the general population, as well as in the target group of patients seeking psychiatric treatment.Sources of Data:Various sources of information were analysed separately, in order to develop and test a prediction rule for excessive gambling, namely the 2002 Swiss Health Survey, which is a survey of the general population, involving 19'706 participants, as well as the data of psychiatric patients of the Lausanne/Geneva - region, recruited consecutively from 1996 to 2004 at the Psychiatric Hospital of the University of Lausanne. This patient population comprised a total of 886 patients. Further data from the Centre for Excessive Gambling in Lausanne are presented, covering 105 patients.Outcomes:Results show that indicators of depressive behaviour as well as smoking are good candidates for the early identification of gambling problems. On the basis of these data it is safe to assume that signs of depressive behaviour should encourage health professionals to enquire about gambling problems.