Psychiatry and primary medicine in Israel.
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Health Services Accessibility↗
Biomedical subjects
B Maoz
Publications and source records attributed to B Maoz.
Modelling the process of encounter between general practitioner and patient as a method for the detection of psychosocial problems.
In the Netherlands all patient on the list of a GP can present with all health problems in all their stages of development at any time, and more than 80% of all complaints presented to a GP are resolved by him or her. Many of these problems have psychosocial aspects. GPs need a structured consultation model for the doctor-patient encounter and, at the same time, need an open consultation style. The model must be seen as an aid in the doctor-patient communication and in medical education. In this article such a model, based on the SOAP system, a system for medical recording is described. Furthermore, a broader protocol of the SOAP, called the BATHE, is introduced. In addition, a description is given of how students at the medical school of Maastricht University are trained to use this model, especially in the clerkship in general practice.
Clinical Clerkship↗
Psychosomatic medicine and primary care in Germany.
The development and training in psychosomatic medicine in Germany are presented. This branch of medicine emphasizes the biopsychosocial understanding of disorders, and psychological, particularly psychoanalytic, methods are used. The outcome of treatment studies are awaited to clarify their role in the medical services of Germany.
Curriculum↗
Application of models of working at the interface between primary care and mental health services in Israel.
Psychiatric morbidity is common in primary care, a large proportion being treated without specialist referral. A significant proportion may be undetected or inadequately treated. This article describes current models of mental health services (MHS) working at the interface between primary care and MHS with review of data regarding these models and discussion of the application of these models to the Israeli health system. The shifted out-patient model, primarily provided by psychiatrists independent of the Primary and Secondary Care Teams, would seem to increase access to psychiatric services, increase treated prevalence of the disorders and attract a similar population to hospital out-patient services. The psychiatric community liaison model aims to improve primary care practitioner detection and management skills, might reduce referrals to psychiatrists with similar patient outcome and enables treatment of patients unwilling to see a mental health professional (MHP). The attached MHP Model would allow access to a greater range of psychosocial interventions provided by a primary care team member. The community mental health team, currently a model not in practise in Israel, provides a single point of referral for multidisciplinary care but has shown varying patterns of integration and responsiveness to primary care. Other interfaces of collaboration such as Balint groups and education are also discussed.
Forecasting↗
The healing significance of the Negev's Bedouin Dervish.
Among the Bedouins of the Negev desert, Israel, there are Dervish healers specializing in what are now called psychiatric disorders. Five Dervish (three male, two female) were interviewed and observed with reference to concepts of etiology, symptom classification, diagnosis, stages of treatment, and aftercare. The conclusion examines reasons why Bedouins might want to seek treatment from a Dervish, rather than a modern health care practitioner.
Adolescent↗
Psychological adjustment among Soviet immigrant physicians: distress and self-assessments of its sources.
The purpose of this study is to examine the psychological distress of Soviet immigrant physicians in Israel and their self-assessed sources of this distress. The subject of this study included 385 (152 men and 233 women) Soviet immigrant physicians who had participated in preparatory licensing courses. The investigation shows that women have higher scores of distress than men in Global Stress Index of the Brief Symptom Inventory and its subscales which reflect anxiety. A comparison of Global Stress Index of the subjects of this study with U.S. and British published non-patient norms shows a significantly higher distress level among the immigrant physicians. Most of the respondents evaluated their psychologic state before immigration to Israel as better (303 or 78.7%). These assessments are found to be directly dependent on the stress load of the respondents at the time of the interview. Perception of the sources of absorption difficulties and distress scores are also found to be in close dependence. The results of the multiple regression analysis indicate that both sex and distress are statistically significant predictors of immigrants' estimation of their difficulties. However, it is the level of distress that has the greatest influence on the assessments of the respondents.
Adaptation, Psychological↗
Ritual female genital surgery among Bedouin in Israel.
Ritual female genital operations are common in many parts of the world, with varying degrees of mutilation from clitoridectomy and removal of the labia to removal of the clitoral prepuce. Interviews of 21 Bedouin women in southern Israel revealed the practice to be normative in several tribes. However, physical examination of 37 young women from those tribes at a gynecological clinic revealed only small scars on the labia in each woman. Bedouin in southern Israel may offer a model of evolution of female circumcision into a nonmutilative ritual incision.
Adolescent↗
Respiratory and other symptoms in panic disorder versus other anxiety disorders.
Respiratory abnormalities have been proposed as a central feature of panic disorder, but the literature is not unanimous. Symptoms of anxiety were quantitatively recorded with the Hamilton Rating Scale for Anxiety (HAM-A) in 72 psychiatric out-patients in two anxiety disorders clinics in Israel; 44 patients had panic disorder with or without agoraphobia and 28 patients had other anxiety disorders. Panic patients had more cardiovascular symptoms, but not more respiratory symptoms, than other patients. The relative importance of respiratory symptoms in panic disorder is not yet settled.
Adult↗
Listening to patients' stories. Storytelling approach in family medicine.
This paper discusses the relevance of a storytelling approach for understanding psychological problems in family practice and assesses the value of such an approach.
Communication↗
Linkage of a normal personality trait to the color-blindness gene: preliminary evidence.
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Adolescent↗
Sexual activity and sex hormone levels in aging men.
A cross-sectional study of 60 men aged 65-80 was carried out to test the impact of the aging process on sexual hormones (testosterone, FSH, LH, prolactin), sexual activity, and the relations between them. Blood samples for hormone assays were taken between 8-9 A.M. in the primary care clinic at which the participants were registered. Data on sexual activity (coitus), sexual desire (libido), marital status, and age were obtained from the respondents by means of a structured interview. No relationship was found between testosterone (T) or prolactin (PL) and sexual activity. Nevertheless, a statistically significant relationship between FSH and LH versus age, and an inverse relationship between sexual activity and age were found. Hypogonadism (T level less than 3ng/ml) with normal levels of FSH and LH was observed in 11 respondents.
Aged↗
Coping with recent life events: the interplay of personal and collective resources.
The importance of personal and collective resources in coping with recent life events was studied among 230 kibbutz members. The sense of coherence, a global life orientation that detects the ability to avoid stressors and to choose appropriate coping strategies and resources, represented personal resources. Collective resources, embedded in the social system to which one belongs, were measured by membership in a religious kibbutz, the kibbutz being viewed as a powerful, collective-coping resource by itself. Physical well-being, psychological distress, and functional limitations were used as outcome measures. Both types of resources have a salutogenic effect, but sense of coherence appears to be a better resource for avoiding the effect of recent life events and for moderating psychological distress and functional limitation after experiencing such events. The two types of resources have no additive effect, nor do they compensate for each other. Only one significant interaction was found, suggesting that the combination of the two resources is useful in avoiding functional limitation. It is also suggested that collective resources have a slight positive effect on personal resources, which, in turn, take over and become most valuable in coping with recent life events. When stress affects social functioning, these same personal resources facilitate the mobilization of whatever collective resources are available.
Adaptation, Psychological↗
Adjustment and distress among new immigrants to Israel.
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Emigration and Immigration↗
Psychological adjustment and distress among Soviet immigrant physicians: demographic and background variables.
The goal of the present study was to examine the psychological distress of Soviet immigrant physicians in Israel and to identify risk and resilience factors in the psychological adjustment to immigration. This is a first report on a study conducted among 385 (152 men and 233 women) Soviet immigrant physicians who participated in preparatory licensing courses. The design of the study is described in detail and initial results are presented. These include demographic characteristics of the sample, background variables connected with motivation for immigration and reported absorption difficulties encountered in Israel. Family problems were found to be significantly correlated with depression: the highest rate of reported depression was found among single parents. Subjects who were examined during the second year after immigration reported depression more often than subjects who were in Israel less than a year. The findings suggest that motivational and family factors may enhance or mitigate the psychological distress experienced by immigrants.
Acculturation↗
Prevalence of psychiatric disorders in three primary-care clinics in Beersheba, Israel. Concurrent assessment by the General Health Questionnaire, General Practitioners, and Research Diagnostic Criteria.
The General Health Questionnaire (GHQ) had identified fully 69% of 776 respondents who attended 12 primary-care clinics as "probable cases" of psychiatric disorders, whereas the general practitioners (GPs) involved had thought only 31% had psychological problems. To investigate more accurately the prevalence of psychiatric disorders we examined 112 of the original sample with the Schedule for Affective Disorders and Schizophrenia, Life-time version and found only 15% to have had a Research Diagnostic Criteria disorder at the time of the initial study. Raising the GHQ threshold to 15/16 improved specificity and positive predictive value, and improved GPs' case-finding modestly. These respondents either suffered from high rates of subclinical distress or readily report subjective distress in the clinic, or both.
Adult↗
Psychiatry and primary medicine.
Psychiatry and primary medicine are related to one another for theoretical and practical reasons. The development of this relationship in Israel in recent years is described. Many patients with mental problems are seen by the primary physician only. The most serious cases are usually detected and referred. The main problem is that people with modest mental disturbances are often neither detected nor referred and treated. The development of various forms of communication between psychiatry and primary medicine, such as consultation-liaison programs, Balint groups and other methods of training, are described and discussed.
Education↗
Life events, sense of coherence and health: gender differences on the kibbutz.
The effects of recently experienced life events (RLE) and of a personal coping resource--the sense of coherence (SOC)--on the health of men and women were investigated among members of two small and cohesive communities--two kibbutzim in Israel (n = 230). Results of analyses lend support to previous findings about the negative effects of life events on health, and to Antonovsky's theory about the positive influence of SOC on health. Separate analyses for men and women, however, show that while RLEs negatively affect women's health, SOC has no significant counterbalancing effect on their health. Among men, an opposite pattern is found; their health is not affected by RLE, but is significantly affected by their SOC. Our findings lead to the conclusion that men and women are differentially affected by stressors and make different use of their coping resources. These findings should be taken into consideration in further research on stress, coping and health.
Adaptation, Psychological↗
Physicians' detection of psychological distress in primary-care clinics.
This study investigated the amount of psychological distress reported by 182 soldiers in the Israeli military and compared soldiers' self-ratings of distress with ratings by military physicians of observed distress. Comparisons indicated a low detection rate by physicians with only 13% of self-reported cases of emotional distress identified. This and several related findings were taken to indicate shortcomings in medical care. Possible remedies include additional psychiatric training for military physicians, less frequent rotation of physicians to allow for more stable care, and the initiation of mental health education among soldiers.
Adult↗