Israel Journal of Psychiatry and Related Sciences最新文献

Objectives: The objective of this study was to highlight and assess the important topic of the voluntary departure of the physician from his/her clinic. We used the topic of the voluntary departure of a family physician from the clinic as an example. The physician's leaving challenges the personal credo regarding the continuity of care, which is a basic concept in Family Medicine, and other professions, too: Psychiatrists are also devoted to long-term doctor-patient care. Leaving a place of work is a significant life event that can be accompanied by stress and even a crisis for the doctor, patients, and staff.

Methods: In this article, we will present four stories, of four family physicians who voluntarily left their practices, written from a reflective point of view, either before or after the actual departure. The stories will be analyzed in a qualitative way, and the central themes and narratives will be defined.

Results: The personal departure stories revealed important personal and systemic themes that emerge from and influence the departure process. Among the themes were: practical and emotional work circumstances; leaving as a grief process; and reactions of patients, staff, and management.

Conclusion: Qualitative analysis revealed that the voluntary departure of the family physician has complex personal and systemic implications.

Practical implications: The combination of Balint group discussions and written reflections can help the physician better cope with the departure and also help patients and staff deal with the separation process.

Background: Measuring the progress of mental health treatment aids in assessment and monitoring of psychotherapeutic outcomes. The OQ-45 is a widely accepted measure of such outcomes. The aim of this study was to validate the Hebrew and Arabic versions of the OQ-45.

Method: Data were collected from three samples: non patient university students (n=189), university mental health clinic patients (n=37), and outpatient mental health clinic patients (n=135). Subjects completed the OQ-45 as well as the BSI and PHQ-9 questionnaires.

Results: Test-retest and internal reliability, and concurrent and discriminative validity of both OQ-45 versions were satisfactory. Sensitivity of the Hebrew and Arabic versions was 0.70 and 0.80, respectively, and the specificity was 0.69and 0.93, respectively. Sensitivity-to-change was noted only for the Symptom Distress (SD) subscale.

Limitations: Sensitivity-to-change was not demonstrated for the total OQ-45, possibly due to a too-short follow-up period.

Conclusions: Adequate psychometric properties of the Hebrew and Arabic OQ-45 suggest that they can serve as useful measures of mental health treatment in Israel.Further research is necessary to confirm norms, cut-off scores and sensitivity-to-change using a larger representative population and diverse types of treatment over a longer period of time.

The Israeli-Polish Mental Health Association (IPMHA) was founded in 2000. It is a unique organization as it is not only one of the many associations for mental health professionals but also a platform for people from distant countries who share an important and traumatic past. IPMHA members have been engaged in studies of consequences of massive trauma, intergenerational transmission of trauma and help for trauma survivors. Keeping in mind the obligation of mental health professions to contribute to an enlightened and tolerant society, the IPMHA members have been trying to deal with "the past in the present," investigating the roots of the harm caused by racial and ethnic hatred, anti-Semitism and other forms of social prejudice. The IPMHA activities included symposia with discussions facilitated by the use of the dynamic group formula. Some of the materials presented in the meetings were published in Polish professional journals. This article reports on the activities of the IPMHA with special focus on the accompanying emotionally loaded problems.

Background: While the presence of comorbid anxiety disorders such as obsessive-compulsive disorder and panic disorder have been well described in schizophrenia, comorbid social anxiety disorder (SAD) has been less emphasized. The goal of this study was to examine the prevalence of SAD in our ambulatory population of patients with schizophrenia.

Methods: A group of 50 outpatients with schizophrenia randomly selected from our public mental health outpatient population was evaluated with the Structured Clinical Interview for DSM-IV (SCID)-schizophrenia section, the Positive and Negative Syndrome Scale (PANSS), the Schizophrenia Quality of Life Scale (SQLS), the Liebowitz Social Anxiety Scale (LSAS) and the Global Assessment of Functioning Scale (GAF). After completion of assessments, a retrospective chart review was conducted on all study patients who met criteria for a diagnosis of SAD in order to determine how many of these patients had been previously given a diagnosis of SAD.

Results: Based on a cutoff score of 29/30 on the total LSAS score, 38% of our sample had a comorbid diagnosis of SAD. Compared to patients who did not suffer from comorbid SAD, patients with schizophrenia and comorbid SAD had lower ratings of quality of life, but similar GAF and PANSS scores. According to the results of the chart review, none of the affected patients had been previously diagnosed with SAD.

Conclusions: According to the results of our study, SAD as a comorbid condition is highly prevalent in schizophrenia and may be under-detected in the outpatient mental health care setting. Furthermore, the presence of SAD may lead to a decreased quality of life for patients with schizophrenia. Further studies should evaluate whether the diagnosis and treatment of comorbid SAD would improve the treatment and quality of life of patients with schizophrenia.

A side effect associated with the use of LSD is the return of perceptual disturbances which anteriorly emerged during intoxication, despite absence of present use. Here we present the case of a patient with a previous history of sporadic and recreational cannabis, alcohol and LSD consumption who reported LSD associated "Alice in Wonderland Syndrome" (AIWS) or Todd's syndrome. AIWS is basically characterized by four frequent visual illusions: macropsia, micropsia, pelopsia and teleopsia. AIWS only appeared during LSD consumption and continued after LSD suspension, namely, Hallucinogen Persisting Perception Disorder (HPPD). This phenomenon did not cause a major functional impairment but provoked sufficient worry and concern due to its persistent continuation. The patient refused medical treatment and continued psychiatric follow-up. At the one year follow-up he reported complete remission. To the best of our knowledge this is the first reported case of AIWS which persist after LSD interruption (HPPD) in the professional literature. Reasons for this intriguing, benign, reversible and apparently harmless side effect are proposed.

Polish psychiatry was since its origin deeply influenced by German (Austrian) and Russian psychiatry. As a larger part of the Polish territory had belonged to Germany or Austria before 1918, many institutions and staff in mental health had a German or Austrian history. During the occupation nearly all mental hospitals were taken over by the Germans, sometimes all the patients, sometimes part of them were murdered, and often the staff members were shot together with their patients. Jews were separated from non-Jews and killed. Some institutions continued to work under German rule and with German directors. This paper will explore these issues from a historical and organizational perspective and address how Polish psychiatry attempted to survive during and after the war.

This study had two aims: 1. To examine whether soldiers who participated in Early Group Intervention (EGI) would show less distress and better functioning and physical health than soldiers who did not participate in EGI, and 2. To examine the contribution of the intervention to participants with repressive coping style. The sample comprised 166 male reserve soldiers who fought in the Second Lebanon War. The intervention was conducted three months after the traumatic event, was based on military protocol, and took place over the course of one day. Data were collected at two points in time (four months apart). The findings indicated that after EGI, the intervention group experienced less post-traumatic distress than did the control group. In addition, four months after the intervention, the functioning and physical health of the intervention group was significantly better than that of the control group. Notably, the intensity of post-traumatic distress before the intervention was lower among repressors and low-anxious soldiers than among soldiers in the other two groups (high-anxious and defensive). No significant differences were found after the intervention with regard to the various styles of coping with post-traumatic distress. Future clinical implications of the findings are discussed.

Background: The effects of creatine on brain metabolism and the potential cognitive enhancing properties of this compound raise the possibility of developing a new augmentation therapeutic strategy in schizophrenia especially in patients demonstrating negative and cognitive symptomatology.

Methods: Seven inpatients with chronic schizophrenia presenting with treatment resistant negative symptoms were enrolled into exploratory treatment study with creatine monohydrate augmentation at a daily high-dose of 10 grams, administered for 6 months. Several clinical rating scales and a computerized cognitive assessment battery were applied.

Results: Creatine treatment mildly improved the schizophrenia symptomatology but there were no significant changes in cognitive functions. Several ward behaviors were also improved. Tardive parkinsonism improved numerically by above 40% in 4 out of 6 patients.

Conclusion: This small, open design study of high dose creatine add-on for 6 months in chronic inpatients with schizophrenia demonstrated only mild positive effects on the patients' symptomatology and behavior and might have beneficial effect on tardive parkinsonism.

Background: Persons with severe mental disorders have higher suicide rates than the general population. Their risk profile needs to be fully explored to better guide suicide preventive efforts. Downsizing the number of beds in psychiatric hospitals and high bed turnover may also affect the suicide risk.

Objectives: To investigate 1) Suicide rates among persons who were ever hospitalized in psychiatric facilities compared to the general population, 2) Associated sociodemographic and psychiatric factors, 3) Changes in rate over time, and 4) Timing of suicide deaths.

Methods: We linked the National Psychiatric Case Register (NPCR) with the national database on causes of death. Suicides in the years 1981-2009 were analyzed for the study group of Israelis aged 18 and over ever hospitalized (N= 158,800).

Analysis: Suicide rates were computed by age, gender, psychiatric diagnosis and year of death, as well as agestandardized rates and rate ratios (RR) for persons in the NPCR compared with those never hospitalized. The proportion of suicides committed by the ever hospitalized from all suicides in the population was calculated. Standardized mortality ratios (SMR) for suicide were computed for the ever hospitalized based on the total suicide rates of the population. A multivariate logistic model investigated risk factors associated with suicide in the ever-hospitalized population.

Results: The age-standardized suicide rate of Jews and Others with a psychiatric hospitalization was 17.6 times higher than that of the non-hospitalized (95% CI 16.7-18.6) and 29.7 times higher for Arabs (95% CI 23.4- 37.9). The rates were higher among females and younger persons. In the years 2007-2009, 30% of all suicides of Jews and Others were committed by persons who had been hospitalized in psychiatric facilities. The SMRs of Jews and Others, which increased at the beginning of the study period, fell steadily until 1995. In recent years they have been rising since 2000 and 2005 among females and males, respectively. One fifth (19%) of suicides of Jews and Others occurred before or on the discharge day, and another 6% and 7% within a week and between a week and a month after discharge, respectively. Logistic analysis showed significantly higher suicide risk for males, those who attempted suicide before hospitalization, persons under age 65 and Ethiopian immigrants. Suicide risk increased with number of hospitalizations.

Conclusion: This study highlights the importance of suicide prevention interventions for persons both during their inpatient stay and who were expected to be followed up in community-based facilities.

Parenting is, in its essence, the domain where adult mental health and infant's mental and physical health meet in a complex and dynamic interplay. Becoming a parent is a developmental challenge in itself, and often exacerbates an existing mental illness, and in turn, maladaptive parenting impinges on the early parent-infant relationship, and on the infant's socio-emotional development and later functioning. The capacity for mentalization is brought as a bridging concept between adult and infant psychiatry. A few clinical vignettes illustrate the dynamic interplay between very young children's vulnerabilities and needs and their parents' strengths and weaknesses, leading to a complex interaction and often to symptoms in both child and parent. In the light of the compelling data about the impact of parental psychopathology on parenting behaviors and children outcomes, there is an imperative need for a working alliance and on-going communication between child and adult psychiatrists.