Israel Journal of Psychiatry and Related Sciences最新文献

While extensive efforts have been made in recent decades to enhance community mental health services around the world and in Israel, less attention has been given to the challenging transitional period from psychiatric hospitalization to community living. The current paper reviews the literature on discharge planning programs, which shows that using an interdisciplinary team and adapting a case management model to include overlapping relationships during the process of changing settings might lead to cost-effective outcomes. It is argued here that the current Israeli reform allows an opportunity to reconsider clients' needs and budget priorities, as doing so might lead to the development and implementation of appropriate discharge planning programs.

Background: Treatment of sexual trauma victims may be fraught with crises. In situations of de-compensation, the frequency of suicide attempts is high, and ambulatory treatment may not always provide the required response. In extreme cases, either in close proximity to the sexual offence or even years later, a more intense intervention is needed. This includes removing sexual trauma victims from their daily lives and hospitalization. Caregivers debate the type of hospitalization needed and the best type of treatment in times of decompensation and dissociation.

Method: This paper depicts a hospitalization model in Israel that has been created to provide a unique and focused solution for sexual trauma victims. The psychological principle of the hospitalization is based on Mann's shortterm dynamic psychotherapy method. The patients are integrated in an acute psychiatric ward in which a variety of psychopathologies, men and women, are treated.

Results: The paper summarizes findings and understandings from the first 100 hospitalizations. The author's main conclusion is that sexual trauma victims need a focused specialized treatment plan to best deal with their complex issues and that hospitalization should be minimized to two weeks.

Conclusions: The author's main recommendation is that funding must be allocated for hospital beds for sexual trauma victims in each region in the country to produce adequate continuity of care for these patients.

Background: Recent research indicates an association between obesity and symptoms of psychopathology, the nature of which remains obscure. This study examined the confounding role of behavioral factors on this association.

Method: One hundred and forty-two overweight/obese subjects who sought treatment for obesity, of both genders (51 males and 91 females), 18 to 64 years old and 139 normal-weight controls of both genders (41 males and 98 females), 18 to 63 years old, were enrolled in this study. We measured psychopathology features, using the Symptom Checklist 90-Revised (SCL-90-R), dietary habits, using the MedDietScore (MDS) questionnaire, and physical activity, using the International Physical Activity Questionnaire (IPAQ). A series of regression models were used to estimate the mediation of dietary patterns and physical activity on the obesity-psychopathology association.

Results: The associations between obesity and depression (β=0.32/β=0.15), obsession-compulsion (β=0.03/β=-0.13), anxiety (β=-0.25/β=-0.12), interpersonal sensitivity (β=0.08/β=-0.04) and psychoticism (β=-0.01/ β=0.025) are accounted for by sedentary behavior and Mediterranean diet.

Conclusions: Our data suggest that modifiable behavioral factors such as sedentary time and dietary patterns positively affect the association between obesity and symptoms of psychopathology.

Recovery as a process through which people reclaim their lives even while continuing to experience symptoms of mental illness has at times been misunderstood or misinterpreted, including being used as an excuse for cutting needed services and supports in the guise of allowing people to pursue their own personal "recovery journeys." In delivering a message of hope to individuals and fostering initiatives to counter the debilitating impact of clinical pessimism, recovery literature has also, at times, paid less attention to the material, social, cultural, political and economic contexts in which people pursue recovery. The importance of these contexts are implied in a 1961 American Report on Mental Illness and Health that argued that people with mental illnesses should be able to live their lives "in the normal manner" in their home communities. We argue for a disability model that provides people with necessary supports and services to make individual recovery possible for persons with prolonged mental illnesses. Another model that has emerged over the past decade to counterbalance this overweening emphasis on the lone individual pursuing his or her recovery journey is citizenship. We discuss this concept and our research on it since the late 1990s. We then argue for "recovering citizenship" as a concept and metaphor to capture the individual recovery process within the context and goal of a life in the community that the citizenship framework supports.

Background: Mental health services for youths in Singapore were challenged by accessibility and resource constraints. A community-based mental health program working with schools and other partners was developed to address the population needs.

Aim: To describe the formation of a community-based mental health program and evaluate the program in terms of its outcome and the satisfaction of the users of this program.

Methods: Based on needs analyses, a community multidisciplinary team was set up in 15 schools to pilot a new model of care for youths. Implemented progressively over five years, networks of teams were divided into four geographic zones. Each zone had clusters of 10 to 15 schools. These teams worked closely with school counselors. Teams were supported by a psychiatrist and a resident. Interventions were focused on empowering school-based personnel to work with students and families, with the support of the teams.

Results: 4,184 students were served of whom 10% were seen by the school counselors and supported by the community team. Only 0.15% required referral to tertiary services. Outcome measured by counselor and teacher ratings showed improvements in the Clinical Global Impression scale and Strengths and Difficulties Questionnaire. These included reductions in conduct problems, emotional problems, hyperactive behaviors and peer problems. Furthermore, prosocial behavior also significantly improved. Preliminary cost effectiveness analyses suggest that community treatments are superior to clinic interventions.

Objective: To compare the mental health status of those who participated in combat related activities during their service with that of soldiers whose army service did not include combat related activities Method: A representative sample extracted from the National Population Register of non-institutionalized residents aged 21 or older of Israel was used in this crosssectional survey. Data on mental health disorders, sociodemographic background and army service were collected using face-to-face computer-assisted interviews.

Results: Combat experience per se was not associated with lifetime diagnosis of PTSD. Former combat soldiers had significantly lower lifetime prevalence and 12 months prevalence of any mood or anxiety disorders including PTSD.

Conclusion: This work is in line with previous literature showing that combat exposure, as such, has limited contribution to lifetime PTSD in some groups of veterans. The inverse relationship between combat exposure and PTSD might be explained by the selection of potential combatants among all recruits and by the heightened preparedness to military life stressors.

Background: The Palestinian population residing in East Jerusalem is characterized by high rates of poverty and unemployment and is subject to discrimination in various forms, including infrastructure of mental health services. Little is known about the help seeking needs and practices of East Jerusalem residents.

Method: We examined socio-demographic and clinical characteristics of a consecutive sample Palestinian residents from East Jerusalem (N=50) who accessed a specially assigned psychiatric clinic in Israel. In addition, we examined the psychological factors associated with emotional distress among these service-users upon entry to care. Participants completed a survey in Arabic that included a socio-demographic questionnaire and measures assessing emotional distress, perceived exposure to discrimination and social support, and mental health stigma.

Results: Participants reported high levels of emotional distress. Female gender, low socioeconomic status, higher perceived exposure to discrimination and higher perceived social support were associated with increased emotional distress.

Conclusions: Findings add to the scarce body of knowledge on specific mental health characteristics of East Jerusalem Palestinian residents.

Introduction: A consultation model between primary care physicians and psychiatrists that has been in operation for 12 years in the Jerusalem district of the Clalit Health Services in Israel is evaluated. In this model psychiatrists provide consultations twice a month at the primary care clinic. All patients are referred by their family physicians. Communication between the psychiatric consultant and the referring physician is carried out by telephone, correspondence and staff meetings.

Objective: Evaluation of the psychiatric care consultation model in which a psychiatrist consults at the primary care clinic.

Method: A questionnaire-based survey distributed to 17 primary care physicians in primary care clinics in Jerusalem in which a psychiatric consultant is present.

Results: Almost all of the doctors (93%) responded that the consultation model was superior to the existing model of referral to a secondary psychiatric clinic alone and reduced the workload in caring for the referred patients. The quality of psychiatric care was correlated with the depression prevalence among patients referred for consultation at their clinic (r=0.530, p=0.035). In addition, correlation was demonstrated between primary care physicians impression of alleviation of care of patients and their impression of extent of the patients' cooperation with the consulting psychiatrist (r=0.679, p = 0.015) Conclusions: Very limited conclusions may be drawn from this questionnaire distributed to primary care physicians who were asked to assess psychiatric consultation in their clinic. Our conclusion could be influenced by the design and the actual distribution of the questionnaires by the consulting psychiatrist. Nevertheless answers to the questionnaire might imply that the consultation model of care between a psychiatric consultant and the primary care physician, where the patient's primary care physician takes a leading role in his psychiatric care, is perceived by family physicians as a good alternative to referral to a psychiatric clinic, especially when treating patients suffering from depression.