Israel Journal of Psychiatry and Related Sciences最新文献

Background: Benzodiazepines (BDZs) abuse was found to cause diverse harmful effects among MMT patients. The current study evaluates prevalence rates of BDZ usage during 19.5 years in MMT, and its relation to patients' long-term retention in treatment.

Methods: All 787 opiate addicts who were ever admitted to the Adelson MMT clinic in Tel Aviv between 1993 and 2012 were studied. Observed and random urine results for BDZs usage were taken a few times every month. Positive for BDZ was defined in each month if at least one of the urines tested positive. Long-term retention was studied using Kaplan Meier analyses.

Results: BDZ prevalence among the MMT patients (ranged from 26 patients in 1994, and 300 to 350 since 2009) was about 35-40% in the last few years, with a "peak" of 61% followed by low rate of 25.4%. Followed up for up to 19.5 years, those who were negative to BDZ upon admission to MMT stayed longer in treatment (mean 8.5y, 95% Confidence Interval [CI] 7.6-9.4) than those who were positive to BDZ when admitted (mean 6.9y, 95% CI 6.2-7.7) (Kaplan Meier analyses p=0.01).

Conclusion: BDZs abuse is highly prevalent among MMT patients. Abuse of BDZ on entry to treatment predicts worse MMT outcome. High and low rates of BDZ abuse may also be attributed to staff tolerance of this abuse; thus, we strongly recommend a strict attitude by staff in order to reduce patients' harm.

Disturbances of mentalization have been increasingly associated with the symptoms and functional impairment of people with psychotic disorders. it has been proposed that psychotherapy designed to foster self and other understanding, such as mentalization-based treatment (mBt), may play an important part in facilitating recovery from psychosis. Here, we present an attachment-based understanding of mentalization impairments. We then outline a neuropsychological model that links disruptions of mentalization associated with disturbances in the caregiving environment to the pathophysiology of psychosis in genetically at-risk individuals. this is followed by an illustration of some of the core mBt techniques for the rehabilitation of the capacity to mentalize as applied to the treatment of a patient with a psychotic disorder.

An array of potential ethical stumbling blocks awaits the editors of scientific journals. There are issues of particular relevance to mental health journals, and others unique to local journals with a relatively small circulation and low impact factor. The blind review system, conflict of interests, redundant publication, fraud and plagiarism, guest and ghost authorship and ghost writing, advertising, language and stigma, patient consent, and "rigging" the Impact Factor are all issues of importance. It is critical that editors are aware and informed of these important issues, and have an accessible forum for evaluating problems as they arise.

The concept of metacognition in the context of schizophrenia has recently received increasing attention in clinical psychology and psychiatry. impaired metacognitive abilities in patients with schizophrenia have been associated with symptomatology, cognition, social functioning and quality of life. in this series of articles published as a Special issue of the israel Journal of Psychiatry, edited by Paul H. Lysaker and ilanit Hasson-Ohayon, several new possible ramifications of metacognition with regard to persistence of symptoms, treatment issues and early recognition of schizophrenia are presented, in addition to corroborations of previous findings relating to the aetiology of impaired metacognition and outcome measures. the present invited commentary focuses on potential implications for a more individualized therapeutic approach to schizophrenia, early detection of at-risk states, and ways to link metacognition with neuroscientific approaches.

Background: This study evaluates gender differences in the prevalence of psychotropic medications use among elderly Israelis and the socio-demographic, physical and mental health correlates of their use.

Method: Data were taken from a national survey that sampled the community-dwelling Jewish population aged 65-94 in Israel. Psychotropic medications were assessed from the list of all medications recorded during a faceto- face interview. The current analysis focused on three medication groups: anxiolytics, sedatives/hypnotics and antidepressants.

Results: A significantly higher use of anxiolytics was observed among women compared to men after taking into account their worse physical and mental health. Age, not being married, sleeping problems and depressive symptoms were significant correlates among men while number of non-psychotropic medications, any life trauma and being married correlated with use of anxiolytics and sedatives/hypnotics among women. The use of antidepressants was low in men and women and was related mainly to disability in ADL.

Conclusions: This study points to possibly overprescribing of anxiolytics among women and low detection and treatment of depression among the elderly in general.

Adolescent suicidal behavior poses a major global public health concern as it is highly prevalent and associated with mortality and morbidity worldwide. Substanceuse disorders are also an issue of increasing concern among adolescents and have been shown to increase the risk for suicidal behaviors. In this review we address emerging issues in the relationship between adolescent substance use disorders and suicidal behaviors. We focus on common hazardous patterns of substance abuse such as binge drinking and poly-substance abuse and point out developing patterns of substance preferences as evidenced by the contemporary widespread use of synthetic cannabinoids. We address these issues in the context of vulnerable populations such as sexual-minority adolescents and youth with co-occurring mental-disorder diagnoses. Finally, we relate to the present and future challenges presented by these issues to implement effective anti-suicidal treatment and prevention strategies in adolescents with substance use disorders.

A unique characteristic of LSD, LSD-like and substances with hallucinogenic properties is the recurrence of some or all the hallucinogenic symptoms which had appeared during the intoxication after the immediate effects of the substance had worn off. This recurring syndrome, mainly visual, is not clearly understood. The terms Flashback and Hallucinogen Persisting Perception Disorder (HPPD) have been used interchangeably in the professional literature. We have observed at least two different recurrent syndromes, the first Flashback Type we refer to as HPPD I, a generally short-term, non-distressing, benign and reversible state accompanied by a pleasant affect. In contrast, the second HPPD Type we refer to as HPPD II, a generally long-term, distressing, pervasive, either slowly reversible or irreversible, non-benign state accompanied by an unpleasant affect. HPPD I and II appear to be part of a broad spectrum of non-psychopathological and psychopathological states reported by hallucinogen users. HPPD I and II may be clinically characterized by prodromal symptoms, onset, content of visual imagery, precipitators, frequency, duration and intensity of perceptual recurrences, severity, course, differential diagnosis, accompanying mood and affect, insight and remission. Pharmacological therapy with or without preceding or following co-occurring psychiatric disorders have been shown to ameliorate this syndrome. A large variety of medications may be utilized to alleviate this condition, but with differential results suggesting several subtypes. The purpose of this manuscript is to provide a clinical-oriented, comprehensive and concise review to treating psychiatrists.

Harm reduction is a general term for pragmatic interventions aimed at reducing problematic behaviors. Emerging from addiction treatments, it is based on the understanding that people will continue to behave in ways that pose a risk to them and their communities, and that an important goal of any treatment program is to minimize the harm associated with these behaviors. Despite its evidence based background, harm reduction is not readily applied in general psychiatry. This is mainly due to the complex ethical dilemmas arising within harm reduction practices, as well as a lack of scientific knowledge and theoretical frameworks essential for dealing with such ethical dilemmas. In this paper we introduce the fundamental theoretical and scientific base of harm reduction strategies, and present three clinical examples of the complex ethical dilemmas arising when working within a harm reduction practice. We finally present a theoretical framework for dealing with the ethical dilemmas and argue this may make harm reduction strategies more accessible in general psychiatry.

A series of studies reveals that patient suicide is experienced by most psychiatrists, particularly adult psychiatrists in the public sector. Psychiatrists respond to patient suicide with symptoms of grief, with an intensity in 25-50% of cases similar to those who have lost a parent and sought help, although the duration is more brief. Patient suicide usually results in psychiatrists becoming more defensive in their practice: extra careful to ask about suicidal ideation, more likely to suggest hospitalization and compulsory care, and seek colleagues' consultation. The frequency of patient suicide and its emotional and professional impact have lead to recommendations that the psychiatrist is supported during the early phase of shock and grief, and receives ongoing support for a period after the suicide. Most families of suicide patients would wish to have contact with the psychiatrist after the event. While distress and fear of litigation may influence the psychiatrist's actions, meeting with the family should be seen as part of care, and the psychiatrist should receive guidance and support in this process.

Background: There is little known about predictors of response to cognitive therapy (CT) for psychosis. This study tests the hypothesis that metacognitive change at both end of treatment and follow-up is associated with positive outcomes in people with psychosis receiving CT.

Method: Patients referred for CT for psychosis were offered CT over a maximum of 30 sessions. Assessments, including interview-based measures of psychotic symptoms and a questionnaire assessing metacognitive worry, were performed at pre-CT, post-CT and one-year follow-up. Data from 32 patients were analyzed.

Results: Significant positive relationships were found between metacognitive worry change scores at one-year follow-up and both positive symptoms of psychosis and particular dimensions of hallucinations. No significant relationships were found between metacognitive change and delusional symptoms.

Conclusions: These results suggest that metacognitive change is associated with symptom change at followup. In particular, these benefits seem most evident in those people experiencing hallucinations. Methodological limitations and clinical implications are discussed.