Israel Journal of Psychiatry and Related Sciences最新文献

Background: Recovery and quality of life are key outcomes emphasized in mental health systems around the world. This study explores the extent to which efforts to facilitate community participation may enhance these outcomes.

Methods: Six hundred and six individuals with serious mental illnesses completed measures of participation, recovery and quality of life.

Results: Small, but statistically significant positive relationships between community participation and recovery and quality of life were found. Additional analyses identified specific participation areas that, if they are important and done sufficiently from the perspective of the respondent, resulted in higher levels of recovery and quality of life.

Limitations: Correlational analyses do not allow for causal explanations.

Conclusions: Results suggest that a greater emphasis on community participation, especially in specific areas that are important to the person and done sufficiently, may facilitate recovery and quality of life in community mental health systems. Implications and possible directions for policies and practices, especially within the context of Psychiatric Rehabilitation services, are offered.

The association between severity of psychiatric disorder and dental disease has not been adequately studied. The aim of the present study was to examine the level of dental caries morbidity and the association with Severe Mental Illness (SMI) and mild/moderate psychiatric disorders. The population sample included patients aged 30 to 50, treated at the Hadassah psychiatric outpatient clinic, after giving written informed consent. Exclusion criteria included eating disorders which are recognized as being associated with several dental pathologies. The term SMI, frequently used in the literature (1), refers to psychiatric patients suffering from a significant mental disorder and implies a greater burden of illness and dysfunction. The SMI group in this study included patients suffering from schizophrenia, bipolar disorder, resistant depression and chronic post-traumatic stress disorder (PTSD). The mild/ moderate illness group consisted of all other psychiatric disorders on Axis I or II according to DSM IV-TR (2).

Background: Social Anxiety Disorder (SAD) is characterized by fear and avoidance in social situations where one is exposed to scrutiny by others. It is possible that automatic thoughts either cause the disorder or maintain it, and thus their examination is warranted.

Method: 30 SAD subjects diagnosed with the MiniInternational Neuropsychiatric Interview (MINI) and 30 healthy controls were administered the Liebowitz Social Anxiety Scale (LSAS), the Automatic Thoughts Questionnaires (ATQ-Negative and ATQ-Positive), the Sheehan Disability Scale (SDS) and the Beck Depression Inventory (BDI). It was hypothesized that the SAD subjects would display more depression and disability, more negative automatic thoughts and fewer positive automatic thoughts than the healthy controls, and that the automatic thoughts will predict the severity of SAD.

Results: SAD patients had higher scores of depression and disability, higher scores on the ATQ-Negative questionnaire and lower scores on the ATQ-Positive questionnaire. The scores of the LSAS subscales were predicted by the scores of the ATQ-Positive and the BDI questionnaires.

Limitations: Moderate sample size and limits of the questionnaires used in the study.

Conclusions: Automatic thoughts may be an important area of research with larger samples. Further studies should be carried out in order to examine if strengthening positive thinking and ablation of negative thinking can reduce SAD symptoms during cognitive behavioral treatment.

Background: Irritable Bowel Syndrome (IBS) is a debilitating condition that affects mainly the patient's mental health and quality of life. There is a gap in the literature regarding the relationship between cognitive appraisals and adjustment to physical and psychological aspects resulting from IBS. The aim of the current study was to explore the psycho-social factors that are associated with psychological distress among IBS patients and the contribution of cognitive appraisal to their adjustment.

Methods: One hundred and three patients diagnosed with Irritable Bowel Syndrome participated in the study. Each participant filled a battery of questionnaires targeting demographic and psycho-social factors. The study variables were analyzed via hierarchical regression along with supplementary analyses of multiple mediation tests of indirect effects.

Results: The findings showed that psychological distress and depressive symptoms among IBS patients are better predicted by their global positive illness cognition appraisal, specific illness cognition appraisal of helplessness, resilience and to a lesser extent by social support, perceived optimism, illness cognitions appraisals of acceptance and perceived benefit. Global positive illness cognition appraisal gives us a sum of positive and negative appraisals into one unified appraisal.

Conclusions: Our findings highlight the salience of cognitive appraisal and resilience in IBS psychological adjustment. It seems that IBS patients might benefit from psycho-educational interventions designed to assist them in reducing their helplessness appraisal and increasing the appraisal of their ability to cope with the symptoms of their illness.

Background: Depression frequently co-occurs with diabetes. The associations between risk factors for insulin resistance and depression and diabetes can help determine the relative importance of factors that contribute toward the comorbidity.

Method: Analyses of the NHANES I (n = 10,025) to examine the cross-sectional relationships between depression and risk factors for insulin resistance at baseline using logistic regression and to explore the longitudinal relationships between risk factors for insulin resistance and diabetes incidence using Cox proportional hazards modeling.

Results: Many risk factors for insulin resistance were associated with depression and diabetes incidence. Depression was cross-sectionally associated with diabetes, but did not increase the risk for diabetes incidence.These counterintuitive results can be explained primarily by the differing relationships between risk factors for insulin resistance, depression, and diabetes.

Limitations: Lack of repeated measures of depression.

Conclusions: Lack of physical activity, hypertension, and inadequate sleep were the risk factors for insulin resistance with the highest associations with both depression and diabetes incidence.

Background: We examined how positive affect (PA) and meaning in life (MIL) conjointly regulate posttraumatic stress disorder (PTSD) symptoms and perceived coping self-efficacy. Hypotheses were guided by a recent holistic model, according to which PA and MIL should compensate for each other in relating to adaptation to high stress.

Method: The sample included 75 Israeli firefighters who took active part in extinguishing the 2010 Mount Carmel forest fire.

Results: PA and MIL helped to compensate for the other, demonstrating that when one of them was low, the other related to higher adaptation. That is, under low MIL, PA related to PTSD symptoms and coping self-efficacy, and under low PA, MIL related to PTSD symptoms and coping self-efficacy.

Limitation: The study design was cross-sectional and therefore precluded any causal inferences.

Conclusions: The findings lend additional support to the holistic model and help to understand how subjective well-being and MIL correlate with adaptation to stress.

Background: Although excessive fears are common in preschool children, validated assessment tools for this age are lacking. Our aim was to modify and provide preliminary evidence of the utility of a preschoolers' fear screening tool, a parent-reported Fear Survey Schedule for Preschool Children (FSS-PC).

Methods: 109 Israeli preschool children (aged 4-6 years) with chronic night time fears (NF) and 30 healthy children (controls) participated. The FSS-PC analysis included: 1) internal reliability, 2) correlations between FSS-PC scores and Child Behavior Checklist (CBCL) measures, 3) differences between NF and a comparison sample of FSS-PC scores, and 4) FSS-PC sensitivity in detecting change in NF following an intervention for NF.

Results: There were low-to-medium positive correlations between the FSS-PC scores and several internalizing scales of the CBCL measures. FSS-PC scores in the NF group were significantly higher than the control children's score. FSS-PC scores had adequate internal reliability and were also sensitive for detecting significant changes in fear levels following behavioral interventions.

Limitations: Unique cultural and environmental circumstances and specific study group.

Conclusions: This new version of the FSS-PC may provide clinicians with a novel and useful screening tool for early assessment of fear- and anxiety-related phenomena of preschool children.

Background: Deep transcranial magnetic stimulation (dTMS) is effective in treatment of Major Depressive Disorder (MDD), and in re-treatment in case of relapse. Our study evaluates the long-term durability of dTMS in MDD.

Method: Seventeen patients that responded to dTMS treatment evaluated. Follow-up period was 9.3 months. Patients were considered as relapsed if: HDRS (Hamilton Depression Rating Scale) score was 16 points or more, in case of change in antidepressants, hospitalization due to exacerbation, referral to ECT.

Results: Six months after last treatment three patients relapsed (17.6%). During the follow-up of 9.3 months, nine relapsed. Relapse rate was 5.6 per 100 person-months. Patients continued to improve in HDRS following the treatment. We have found number of treatment sessions, stimulation, age, age of depressive disorder onset, length of depressive episode prior to the first treatment, as well as number of depressive episodes to have no predictive value regarding propensity to relapse in these patients.

Limitations: The study's main limitations are the relatively small sample size, patients differing in follow-up periods and the lack of a control group.

Conclusion: Relapse rates after dTMS are comparable to pharmacotherapy and ECT.

Background: Assessment of risk of violent behavior in forensic psychiatric practice is a complex and responsible clinical task and the use of a valid instrument can make the expert's work more effective. The Historical Clinical and Risk Management scale 20 (HCR-20) is a widely accepted measure of the risk of violence, sexual and criminal behavior. The aim of this study was to validate the HCR-20 in Israeli psychiatric inpatient settings.

Method: In a prospective design, data were collected on 150 male patients aged 15-65, diagnosed with ICD-10 schizophrenia, who were hospitalized in three wards: an acute psychiatric ward (n=50), a high security ward (n=50), and an open ward (n=50). The HCR-20, as the predictor measure, and the Positive and Negative Syndrome Scale, as a concurrent measure, werecompleted at baseline, and the Violence Assessment Scale, as the outcome measure, was completed at 6-, 12- and 18-month follow-up points.

Results: Internal consistency reliability was good for the total HCR-20 scale, satisfactory for the H-subscale, but low for the C- and R-subscales. Concurrent validity was good for the C-subscale, and discriminative validity was reasonable for the C- and H-subscales. The total scale as well as the Historical and Clinical subscales predicted the risk of physical as well as physical/sexual violent behavior at both 6- and 18-month follow-up points.

Conclusions: Appropriate psychometric properties of the HCR-20 suggest that it can serve as a useful measure of the risk of violent behavior in psychiatric settings in Israel. Further research is necessary to confirm norms and cut-off scores, using a larger representative sample.

Background: Emotional distress (ED) is prevalent among immigrants. The open clinic of Physicians for Human Rights (PHR)-Israel provides free medical and psychiatric treatment to immigrants without access to the ambulatory health service. In 2010, the psychiatric records represented 1% of the total medical files (N=28,000) in the open clinic.

Objective: To compare service users' self-reported ED and its identification by general practitioners (GP) and to identify socio-demographic variables associated with ED.

Method: A convenience sample (N=97) of the general medical service users completed the 12-item version of the General Health Questionnaire (GHQ-12). A score of 11 or above was considered a suspected mental disorder. The GPs' clinical assessment of ED was compared with the self-reported score.

Results: The sample's mean GHQ-12 score was higher than the threshold (M=12.7, SD=6.3, range 0-35). Fifty three percent (n=51) had a GHQ-12 score higher than 11, and 8% (n=8) were identified by the GPs as emotionally distressed and/or in need of psychiatric care. The mean score of the study sample was higher than that found in past studies regarding the Arab-Israeli general population (M=10.8, SD=0.35). Employment was the only socio-demographic variable significantly associated with ED.

Conclusions: ED was high among immigrants, but under-diagnosed by GPs. Employment might serve as a protective factor for ED.