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Biomedical subjects

E Witztum

Publications and source records attributed to E Witztum.

At least 73 records · Page 4Linked to original sources
PubMed1994

The influence of cultural factors on obsessive compulsive disorder: religious symptoms in a religious society.

Judaism is one of many religions that demand cleanliness and exactness, inculcate the performance of rituals from childhood and view their non-performance as wrong or sinful. Rituals concerning cleanliness and exactness are the commonest presentations of OCD. In a sample of 34 psychiatric out-patients with OCD in north Jerusalem, religious symptoms were found in 13 of the 19 ultra-orthodox patients, and in one of the 15 non-ultra-orthodox patients. Nine of the 15 OCD patients with religious symptoms also had non-religious symptoms. Four main topics of religious symptomatology were found: prayer, dietary practices, menstrual practices and cleanliness before prayer. The dictates of religious codes regarding these topics are presented and the law is rigorous in its demands, in many cases encouraging repeating rituals. Nevertheless, repetitive performance of religious rituals is recognized by OCD sufferers and their rabbis as expressing psychopathology rather than heightened spirituality. The forms of the religious obsessions and the associated rituals in this sample were similar to the presentation of OCD in non-religious patients. Religion appears not to be a distinctive topic of OCD, rather it is the setting for the condition in very religious patients.

Adult↗
PubMed1994

[Risk of suicide in young drug addicts].

A high risk of suicide was found in young drug addicts. The risk was especially serious when drug addiction was accompanied by severe personality disorder, depression, or both. Lifetime rates of completed suicide in drug addicts are estimated at 2.5-7.0%, and rates of suicide attempts at 8.0-17.2%. These age-adjusted rates are 5-20 times greater than for the general population. 2 cases of completed suicides by drug addicts in a psychiatric hospital, a man of 32 and a woman of 26, are presented. We recommend increased precaution in handling drug addicts, as for depressed patients with a high suicide risk.

Adult↗
PubMed1994

[Ephedrine psychosis].

Ephedrine has both alpha- and beta-adrenergic activity, and both direct and indirect effects on receptors. Its stimulatory effects on the central nervous system are more prolonged, though less potent, than those of adrenalin. It raises blood pressure both by increasing cardiac output and inducing peripheral vasoconstriction. It is still commonly used as a bronchodilator. However, since prolonged use leads to decreased effectiveness, patients tend to increase the dose themselves. The clinical picture of ephedrine psychosis resembles that induced by amphetamines: primarily a paranoid psychosis with delusions of persecution and auditory and visual hallucinations in a setting of unclouded consciousness. We present a 57-year-old woman who had been taking a usual dose of ephedrine for bronchial asthma (50 mg 3 times a day) for more than 30 years. When her husband died she developed depression, for which she tried to use ephedrine as an antidepressive, increasing the dose to 500 to 1000 mg a day over the course of half a year. She developed paranoid psychosis with delusions of persecution and auditory hallucinations, despite a clear sensorium. Recovery was rapid after ephedrine was gradually reduced to 200 mg a day and a small dose (200 mg) of the neuroleptic thioridazine was added.

Asthma↗
PubMed1993

Working with Jewish ultra-orthodox patients: guidelines for a culturally sensitive therapy.

The epistemological gap between the medical reality of mental health practitioners and the sacred reality of their Jewish ultra-orthodox patients poses a major challenge for therapy. Based on our work with psychiatric patients from the ultra-orthodox community of northern Jerusalem, we propose a set of guidelines to cope with this challenge. Basically, we seek to incorporate religiously congruent elements, composed of metaphoric images, narratives and actions, into the wide range of our "secular" treatment modalities in order to respond to the patient's suffering, often expressed through distinctively religious idioms of distress. This endeavor calls for "a temporary suspension of disbelief" on both sides. The guidelines presented include three sets of factors which appear pertinent to working with ultra-orthodox patients. The first set is contextual in nature, dealing with the image of the clinic and its physical setting; the second discusses the necessary role requisites of the therapists; and the third one, accorded a central importance, deals on various levels with the therapeutic interventions administered in terms of form and content. Several case vignettes are presented to illustrate three classes of religiously informed interventions: healing rituals, dream interpretation, and the use of culturally congruent metaphors and stories. In the concluding part we discuss ethical and instrumental issues that the proposed therapeutic guidelines may raise.

Acculturation↗
PubMed1992

Recent trauma in psychiatric outpatients.

Psychiatric clinic outpatients were screened for recent traumatic events, and post-traumatic symptomatology was evaluated in those reporting occurrence of one or more events within the two years prior to screening. Clear symptoms of post-traumatic stress disorder were revealed in 18% of the reporting patients, and the distribution of diagnoses was found to be different in the trauma-reporting group than it was in a comparison diagnostic group.

Adult↗
PubMed1992

The belief in the transmigration of souls: psychotherapy of a Druze patient with severe anxiety reaction.

In this paper the culture-sensitive psychotherapy of a 19-year-old Druze patient with severe anxiety reaction is described. The patient explained his anxiety and his symptoms as stemming from violent death in his former life and subsequent transmigration. The therapists joined the patient's explanatory model and previous traditional healing, adding hypnotic suggestion which relieved the symptoms. The relationship of patient symptomatology to cultural background, multiple personality disorder, possession and dissociation is discussed. The strategic combination of culture-specific and modern psychiatric approaches is advocated in similar cases.

Adult↗
PubMed1992

Mysticism and psychosis: the fate of Ben Zoma.

This paper examines the link between psychosis and mystical study through the cases of four young men who 'entered the garden' of Jewish mystical speculation and subsequently became psychotic. The role of such study as a precipitating factor is suggested, as three had no signs of disturbance prior to their mystical studies. All had suffered personal losses, and their choice of mystical texts and rites showed that their attraction to mysticism included a search for atonement for guilt they felt over their loss. The features of normative mysticism are presented with each case and it is apparent that hallucinations, grandiose and paranoid delusions, and social withdrawal, are phenomena that do not distinguish the psychotic from the mystic. Diagnosis of psychosis is made on the basis of duration of the state, ability to control entry into the state and the associated deterioration of habits, particularly the neglect of daily religious duties. These findings emphasize the need for the examining psychiatrist to be aware of the cultural background, despite the presence of seemingly florid psychopathology. Four eminent Rabbis entered the garden of mystical speculation. Ben Azzai glimpsed and died. Ben Zoma glimpsed and was damaged (lost his sanity). Elisha ben Avuyah lost his faith. Rabbi Akiva departed in peace.

Adult↗
PubMed1992

The association between adolescents' attitudes toward suicide and their psychosocial background and suicidal tendencies.

The present study examined the relationship between adolescents' attitudes toward suicide and their psychosocial background. It also evaluated the association between attitudes toward suicide and the subjects' own suicidal tendencies. A questionnaire assessing these issues was administered to 525 Israeli adolescents. Results indicated that significantly more females, nonreligious adolescents, those exposed to suicidal behavior, and those with increased suicidal risk held more accepting attitudes. Ethnic origin, socioeconomic status, and living in intact/nonintact families were not associated with adolescents' attitudes toward suicide.

Adolescent↗
PubMed1992

The prevalence of posttraumatic psychopathology in the general and the clinical population.

Since the beginning of psychiatry, there has been a controversy about the consequences of traumatic events. Although there is no real dispute about human suffering caused by extreme stress events, social scientists have wondered whether traumatic events could lead to lasting psychopathology. This dispute was very strong in the first two versions of the the diagnostic and statistical manual of the American Psychiatric Association, which came out in 1952 and 1968. In DSM I (1), trauma could only lead to "gross stress reactions", which were part of "transient situational personality disorders". Extreme stress events were thought to lead only to a transient/temporary disturbance and if there was more disturbance than that, another diagnostic label had to be found. This attitude towards trauma has changed over the years and from 1980, in DSM III, there emerged the Posttraumatic Stress Disorder, a disorder which can be lasting or transient (2). In the past years, it has become clear that posttraumatic stress disorders are not the only form of psychopathology that follows after traumatic events. Major depressive episodes and dissociative disorders can also follow traumatic events. In this article, the results of two studies are reviewed. The first is a survey of the major studies into the prevalence of disorders after traumatic events. The main conclusion of this study shows that about 20% of the people that go through severely distressing events develop severe disorders. The second study focuses on the prevalence of disorders in the process of coping with traumatic events in a psychiatric outpatient clinic. Results of this study showed that clinically significant signs of these disorders were found to be present in 18% of the psychiatric outpatient referrals. In the discussion, the conclusion is drawn that posttraumatic psychopathology is a phenomenon that every clinician is confronted with on a regular basis. We might then wonder why specific treatment for posttraumatic psychopathology is still such a neglected area in psychiatry and psychotherapy.

Adaptation, Psychological↗
PubMed1992

Labeling and stigma in psychiatric misdiagnosis.

Labeling and stigma in mental disorders occupy a central place in both mental health theory and practice. Some of the problems involved in making psychiatric diagnoses are reviewed. A case description is presented, demonstrating the dangers and complications of labeling and stigma. The irreversibility of labeling and stigma in psychiatric misdiagnosis is emphasized and discussed.

Decision Making↗
PubMed1991

Short-term strategic treatment in traumatic conversion reactions.

The therapists applied the strategic approach in four cases that demonstrate a variety of traumatic and conversion reactions. The therapists accepted the definition of the problem as presented by the patients or their families at the overt level, and were able to treat the conversion symptoms. At the latent level, however, there were additional system-focused goals. In the first stage, the therapists strove to understand the inner world and cultural background of their patients, their dynamics and the circumstances surrounding the event that led to the conversion reaction, or the traumatic significance of the event when it was a posttraumatic conversion. It was then possible to develop a strategy for treatment and to decide which treatment techniques were appropriate. The therapists created situations that encouraged change and pushed the patients to abandon the symptom. This therapy model is composed of behavioral and paradoxical techniques based on the understanding of the dynamic material and cultural content.

Adolescent↗
PubMed1991

Problems in the treatment of religious patients.

Members of religious groups are bound together by doctrine, ritual, and social organization. These factors also separate religious people from members of other groups or cultures. This division is apparent during interactions with other groups, and critical when members of religious groups are referred for help for psychiatric problems. In this paper we discuss four problems that therapists may encounter with strictly religious patients. Religious patients are often suspicious of secular therapists and therapy, and therapists too, may be influenced by their personal attitudes toward religion. Differentiating religious beliefs and rituals from delusions and compulsions is difficult for therapists ignorant of the basic tenets of that religion. Clinical examples of the four problems are presented from our work with patients from the ultra-orthodox Jewish community of North Jerusalem and we provide guidelines for their resolution. Therapists need a basic knowledge of the religion's doctrines and rituals, should assess patients using its terminology, and approach the patients through the social organization of their religious group. We consider that attention to these issues is vital for effective communication and assessment of strictly religious patients.

Adult↗
PubMed1991

Ideology and budgeting.

Israel has undergone rapid change and development during the last few decades, and extraordinary advances have been made in the field of psychiatry. At the same time, however, it is this progress that has outdated certain methods and styles of public service planning. Universal accessibility to good treatment is put at risk by the centralized planning that is more concerned with bed utilization and less so with community services, now the heart of the psychiatric system. While general health services are undergoing reorganization, progress has been slow in the restructuring of the psychiatric system.

Community Mental Health Services↗