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Introduction: The bio-psycho-social model is mostly used to understand the etiology and pathogenesis of psychiatric disorders. Even though in our era, the biological factors became more dominant in the field, the stress-diathesis model is quite acceptable to explain and understand the evolution of psychotic as well as affective disorders.

Background: In this case report we present a patient, in her late 40's, admitted to our department with a manic-psychotic episode for the first time in her life, after the massive terror attack of October 7, and in which we suggest that the signs and symptoms might be explained using the psycho-dynamic theory.

Conclusions: We conclude suggesting that the equilibrium of the bio-psycho-social model, should be adjusted in the context of time and space, especially during a situation of catastrophic scale in the patient environment.

Discussion: Although stress is a risk factor for the development of affective disorders and especially manic-psychotic episodes, there is scarce literature to support it. On the other hand, psycho-dynamic theories sometimes consider stressful life events as a causative factor for the development of depressive as well as manic episodes.

Introduction: Since the brutal October 7, 2023 attacks on Israel, the encroachment of the battlefield into the daily lives of all Israelis has impacted both civilians and combatants in various ways. The development of post-traumatic stress reactions has far-reaching effects across numerous aspects of life. One of the lesser-discussed consequences is the onset of sexual dysfunction. Reactions to such distressing events can adversely affect sexual desire, arousal, orgasm, the frequency of sexual activities, and satisfaction derived from them. These issues may present directly in clinical settings, or indirectly through other symptoms. The impact of trauma on sexual function can be attributed to disruptions in biological mechanisms, cognitive impairments, mood changes, and diminished motivation. This review explores how responses to post-traumatic stress relate to sexual function. We present case studies of patients recovering from such events, describe the underlying mechanisms that trigger these adverse reactions, and discuss interventions that can enhance sexual health, which can be implemented in primary care settings. It is advisable for assessments of sexual function to be included in routine evaluations by primary care physicians. Early identification of sexual dysfunction can help prevent the progression of more persistent issues and enhance overall quality of life for patients.

Introduction: Letter about JEWISH MEDICAL STUDENTS FROM BRITISH MANDATE PALESTINE/ERETZ ISRAEL -THEIR FINAL MD EXAMINATION IN BERLIN DURING THE THIRD REICH, by Uri Freund Letter about JEWISH MEDICAL STUDENTS FROM BRITISH MANDATE PALESTINE/ERETZ ISRAEL -THEIR FINAL MD EXAMINATION IN BERLIN DURING THE THIRD REICH, by Gideon Eshel Letter about THE UNACCEPTED RELATIONSHIP BETWEEN THE EDUCATIONAL MEDICAL SYSTEM IN GERMANY AND THE JEWISH PHYSICIANS DURING THE NAZI REGIME, by Gideon Eshel.

Introduction: Delivery of the returnees from captivity by the Red Cross to military mental and medical professionals until they transfer to the medical staff in the hospitals and meetings with their families is a decisive challenge for the returnees and the professionals. The absorption time places the returnees in an exposed and vulnerable situation, in an intermediate space between captivity and reintegration into reality. The feelings of terror, the helplessness, and the danger to life that accompanied the kidnapping and the stay in captivity may develop into situations related to survival and adaptation to the conditions of captivity, including life-saving strategies. In addition, captivity is characterized by asymmetrical and distorted relationships. These distorted relationships, acquired in captivity without any choice, can have long-term consequences on future relationships and the process of adapting to life upon returning to Israel. Moreover, the fact that the reality that surrounded the returnees involved the loss of family members or others who were with them at the time of the kidnapping or during their stay in captivity adds to the complexity and the necessity of a sensitive and specially adapted professional reference on the part of the professional system. The expected reactions at the time of absorption can be varied and range from joy and euphoria to sadness, a feeling of alienation, anxiety, and disconnection. The initial reception time may be a window of opportunity during which interventions can be made to achieve effective adaptive responses upon returning to Israel. The purpose of the present article is to describe the preparations made in a relatively short period for the reception of the returnees and the development of the protocol for their initial reception to provide the best response to their needs. The protocol that is at the center of this article was formulated in the combat reaction unit, taking into account the needs of the returnees and the expected responses. Critical professional principles are applied, including an initial mental assessment, connection to personal, family, and community resources, as well as connection to the medical team, for continued treatment in the medical centers.

Introduction: We present a case study dealing with the emotional coping of a physician's exposure to continuous traumatic stress starting with the events of Oct. 7, 2023 and during the following months.

Background: The medical staff at Soroka Medical Center in southern Israel have faced unprecedented challenges over the past months due to ongoing conflict along the Gaza border. Since October 7, 2023, over 2,550 wounded patients have been treated at Soroka for injuries of varying severity, with more than 250 requiring life-saving surgeries. As the region's largest trauma center, Soroka's staff have endured continuous exposure to traumatic stress, suffering, distress and grief - both within the hospital and in their personal lives.

Conclusions: While the long-term impacts remain to be seen, preliminary findings suggest that organizational efforts during routine may help mitigate potential negative effects of exposure to traumatic stress in the course of emergency. Further research is needed to understand how cumulative exposure interacts with process of recovery and growth.

Discussion: The current report presents the different layers of traumatic exposure, the associated risk and resilience factors and a perception that was instilled in the hospital in the years preceding the current war which promoted a culture of proactive peer discourse about emotional hardship and normalization of referral for professional help when needed. We also present coping behaviors that were common among many staff members and organizational responses, considering the uniqueness of the current challenges, their scope and duration.

Introduction: On October 7, 2023, terrorist organizations led by Hamas, launched an extensive attack on Israel. Within days following the initial attack, there was a clear need to provide psychological support to individuals who were exposed to the horrors of the October 7 attacks. Hence, the Tel Aviv Sourasky Medical Center opened the "Ichilov Otef Nefesh" clinic to provide psychological first aid to the first-line victims of the war. As the fighting spread, the services were extended to the entire population. The guiding principle of the intervention was that it is crucial in the acute phase after exposure to significant trauma, and its main purpose is to support the natural course of one's recovery processes. This case series describes three representative cases from among the hundreds of people who applied to the clinic. The intervention provided was guided by an integrated approach that promotes introspection and connectedness to one's environment and community, enhancing cognitive functions, emotional regulation and utilizing available resources to reduce distress. The main themes that emerged shifted between feelings of helplessness and a sense of agency; a breach in basic trust and renewed trust, guilt and self-compassion; anger, abandonment and alienation versus solidarity and connecting to the present and the future, despair versus hope and loss versus acceptance and connectedness. In face of these, the therapists endorsed techniques of validation, restoring self-agency, promoting a sense of self-agency and self-compassion, creating a link between the past and present, and finding connection and hope.

Background: On October 7, 2023, operation "Iron Swords" erupted following a barbaric terror attack, resulting in over 1,200 casualties, with more than 250 individuals, abducted. The aftermath of this slaughter led to the evacuation of hundreds of thousands from their homes in both the south and north of Israel. This situation triggered an unprecedented surge in the request for mental health support as reported by health funds and helplines. Global observations of large-scale traumatic events indicate increased usage of mental health services. The question then arises regarding the scope of services required in response to the mega-atrocity of October 7.

Objectives: To chart the utilization of psychiatric clinical treatment services in Israel in the aftermath of the October 7 attack.

Methods: This is a retrospective cohort analysis using the electronic database from the research division of Clalit Health Services. We performed a comparative charting of mental health clinic treatments among individuals aged 15 and above, focusing on October-December 2023. These data were then compared to corresponding months over the previous five years (2018-2022).

Results: From October to December 2023, there was a 23.2% increase in the requests for mental health clinic treatments, compared to the same period in 2022. This surge extends a continuing upward trend in the utilization of mental health services observed since 2018.

Conclusions: The study results emphasize the necessity for a responsive and flexible mental health system, to address immediate and long-term psychiatric care needs. The insights derived from these data are crucial for policymakers and clinicians to restructure mental health services, aiming to enhance the quality and accessibility of care for the Israeli population.

Discussion: The consistent rise in utilization of clinical mental health services significantly intensified following October 7, 2023. This echoes trends observed in global studies, underscoring the profound and enduring effects of traumatic experiences on mental health. These insights highlight the necessity for ongoing, high-quality therapeutic services and underscores the critical need for strategic policy development and increased investment in mental health services.

Introduction: Eating disorders (EDs) are severe psychiatric disorders which entail substantial morbidity and mortality. Early detection and treatment are fundamental in determining prognosis. Exposure to traumatic events and acute stress are prominent risk factors for the emergence of EDs, while treatment delay may cause medical and psychiatric complications and lead to chronic illness. We describe a case series of two patients who recently presented to our center with anorexia nervosa, in which the latest events of the October massacre and the Iron Swords war were central in clinical deterioration and seeking treatment. We elaborate on the mechanisms in which the current emergency state may affect eating routines and lead to the development of EDs and emphasize the pivotal importance of efforts for early detection of new cases of EDs together with monitoring depression, anxiety, and post-traumatic symptoms. Given the heightened risk for the emergence of EDs at this time, early detection by health agents including parents, teachers, "resilience" centers and primary medicine teams is essential. We indicate that plans for early intervention that were prepared following the COVID-19 pandemic, may be implemented by family doctors and community-based dieticians to initiate therapy until treatment in a specialized ED center.

Introduction: The Soroka University Medical Center has treated thousands of wounded civilians and soldiers since the outbreak of the "Swords of Iron" war. The mental health division in Soroka treated many patients suffering from acute and multisystemic injuries, during hospitalization in the intensive care units and other departments. Data on the uniqueness of the mental health interventions in these situations is scarce. In this article we will explain the characteristics of the mental health interventions in three representative cases emphasizing principles for a short and focused intervention, aiming to reduce the risk of developing post-traumatic syndrome or other stress related disorders.

Introduction: Following the onset of the "Iron Swords" war, Israel's National Emergency Medical Organization Magen David Adom (MDA) implemented a program designed to prevent post-traumatic sequelae among its teams. 'Team debriefing' is at the core of the program, which also includes primary, secondary, and tertiary prevention carried out regularly to preclude psychological harm to employees and volunteers. Apart from the initial team debriefings, MDA's enhanced prevention program includes several other components and stages. Beginning on October 9, 2023, potentially traumatized teams met with senior mental health professionals: a refresher course on how to conduct debriefing sessions was offered to assist managers and senior staff to plan for appropriate prevention responses. Personal follow-ups were enacted by MDA's Human Resources Department for all team members living in southern Israel and others who took part in operations there when the war first broke out. Periodic team discussions were held for potentially traumatized staff and volunteers with senior mental health professionals. Meetings with senior mental health professionals via two modes of video conferencing were conducted: specialized meetings with at-risk teams and open meetings for the entire organization in the webinar format. A centralized referral system was expanded for assessment and immediate treatment, if necessary, by mental health professionals for employees and volunteers in need. We trust that these measures will enhance the operational readiness of the MDA staff and volunteers in the face of their increased workloads and the associated psychological pressures. We are convinced that the prompt implementation of a debriefing strategy within our organization cultivates resilience and confidence in the MDA teams, promotes a sense of togetherness among the personnel, and advances a state of readiness and operational alert.