Biomedical subjects
Publications and source records attributed to Y Lerner.
A patient with schizoaffective disorder and anticholinergic refractory neuroleptic-induced parkinsonism manifested a marked increase of parkinsonian symptoms and dystonia after ECT. This is the first report in the literature of such an unusual reaction of parkinsonian and dystonic symptoms to ECT.
The distinction between schizophrenia and affective disorders is fundamental. However, overlapping has been described in most studies of schizophrenia and of affective disorders. We studied 20 families, each with at least 1 parent and 1 child with a diagnosis of schizophrenia or of affective disorder. In half the families there were 2 diagnoses. In most of these families the children had a more severe disorder than the sick parent, onset was earlier, more were diagnosed as schizophrenic, hospitalizations were longer, and social functioning was worse. The results emphasize current problems in psychiatric diagnosis, which still lacks a pathophysiological etiologic basis.
A descriptive study of all the admissions to a psychiatric hospital in Israel during the first month of the persian Gulf War was carried out. There was no decline in the number of admissions, and all the admitted 31 patients were civilians. War-related symptoms were manifest at the admission of 12 patients. Delusions of war-related content were prevalent, sometimes with corresponding hallucinations; three cases with these features are described briefly. There appeared to be an over-representation of female patients whose families originated in the Persian Gulf area. These findings may help in the planning of psychiatric services for similar future emergencies.
This paper presents the Israeli norms for the Achenbach Child Behavior Checklist. Questionnaire data were collected on a clinically-referred sample (N = 2227) and a non-referred sample (N = 1275) of children between the ages of 4-16. Basic descriptive data for total behavior scores and scores for broad-band and narrow-band syndromes by sex, age group, and clinical status are presented. The mean total behavior score in the non-referred sample is similar to that reported for American and Dutch samples. For the Israeli referred sample, the mean total behavior score was considerably lower than that reported for the American and Dutch samples. Issues involved in selecting an optimal cutoff point to discriminate between clinically-referred and non-referred populations are discussed.
The present study compared the pattern of service utilization over a 1-year period, of 349 newly referred adult patients to the four community mental health clinics in Jerusalem. Treatment in these clinics is provided free of charge and there are no limits on length of treatment. Irrespective of patient diagnosis and clinic setting, the percentage of patients remaining in contact with the clinics declined sharply during the first 3 months, and after 6 months stabilized to around 25-40%. However, among patients with nonmajor psychiatric disorders, inter-clinic variation in compliance with treatment was observed. In clinics with a long-term psychotherapeutic orientation, a larger proportion of patients was referred to other services following intake, and a larger proportion of patients dropped out of treatment. In these clinics, more patients were placed on waiting lists before beginning treatment, and the drop-out rate among these patients was significantly higher than that of patients in treatment. The implications of these results for treatment policy in public services are discussed.
This study attempts to predict the need up to 1995 for psychiatric beds in Israel, based on the trends of psychiatric hospitalization during 1986-1990. Additional need created by the recent large waves of immigrants to Israel are taken into account. Analysis was separate for chronic in-patients, (continuous stay of 1 year or more) and for acute in-patients (stay of less than 1 year). The data were drawn from the National Psychiatric Case Register. Among acute in-patients, the admission rate of immigrants was higher than that of the veteran population, thus counterbalancing the trend to a decrease in admissions among the latter. It is assumed therefore that the present rate of 0.4 acute patients/1000 population will not change. However, an additional 300 new beds will be needed due to increase in the general population. With regard to chronic in-patients, a continuous decrease of about 50 chronic in-patients per year has been observed. Assuming 700,000 new immigrants will have arrived in Israel between 1990-1995, and that the proportion of patients admitted who remain in continuous hospitalization is larger among new immigrants than among the veteran Israeli population (10% vs. 6%), the beds expected to be vacated by chronic patients will be filled by new immigrant patients. The expected rate of chronic in-patients will nevertheless decrease from the present rate of 1.0/1000. to 0.8/1000 by 1995.
Abuse of alcohol and other drugs by mental patients has been reported extensively in the past decade, especially in the USA. It has seemed to us that drug abuse has become more common among mental patients treated at this psychiatric hospital and at outpatient clinics in Jerusalem in recent years. Therefore, 100 patients admitted consecutively were questioned with regard to alcohol and drug abuse. A quarter of the male patients were diagnosed as having both a psychiatric disorder and drug abuse. Drug abuse was even more common among male schizophrenics aged 26 to 35, but only 2 reported alcohol abuse. Drugs used were mainly opiates (heroin and methadone) and hashish, and in most cases both. The results indicate that mental patients, especially young men with schizophrenia, may be another risk group for drug abuse in Israel.
Maternal and environmental characteristics as predictors of behavioral problems and cognitive competence in 505 Israeli kindergarten children were investigated. Events in closer temporal proximity to assessments of functioning appeared more predictive than those in early infancy. Findings support the need to include variables reflecting maternal characteristics in any prediction of child outcome and to consider the sex of the child in selection of variables.
Psychiatric epidemiology in Israel began with the inauguration of the Psychiatric Case Register in 1952. Periodic statistical reports by the Ministry of Health Mental Health Services, as well as several Case-Register-based epidemiological studies, have since been published, all of which have related to in-patient data. Community psychiatric surveys have primarily included populations in treatment. The most comprehensive study was carried out on a nationwide basis in 1986 in collaboration with the Nathan Kline Institute. However, only a few community surveys of the general population have been carried out thus far in Israel. The population studied was not nationally representative, and the more advanced screening and diagnostic instruments were not utilized. The necessity for a large-scale, multi-centered community survey in Israel, similar to the Epidemiological Catchment Area project in the U.S.A., is suggested. Furthermore, the particular needs of recent and future waves of immigrants must be taken into consideration.
A survey of the long-term users of community mental health clinics in Jerusalem was conducted in 1986. The study population included all patients in regular contact for at least one year (789 patients). Data on clinical diagnosis, type of treatment and selected sociodemographic variables were extracted from the patient's file at the clinic. Long-term utilization rates were calculated for the different catchment areas and for different sociodemographic and diagnostic groups. It was found that for patients suffering from major psychiatric disorders (2/3 of the long-term users), the long-term utilization rates were similar across catchment areas, and higher in those socioeconomic groups that are also reported to have high true prevalence rates. On the other hand, for patients suffering from non major psychiatric disorders, the long-term utilization rates varied between clinics, reflecting local treatment policies, specifically the extent to which the clinics use psychotherapy as a treatment modality.
Child Behavior Checklists (CBCL) were completed by parents of 450 clinically referred Israeli boys aged 6-11. Principal components analyses with varimax rotation yielded 10 syndromes: aggressive, uncommunicative/social withdrawal, depressed, delinquent, hyperactive, somatic complaints, anxious, immature, unpopular, and odd. The first seven syndromes were highly correlated with American and Dutch syndromes derived from the CBCL providing further evidence of their cross-cultural robustness.
A nationwide random sample of psychiatric patients (n = 832) admitted for hospitalization in Israel in 1980 was followed up until the end of 1984. A multivariate analysis was performed, where the dependent variables were: the cumulative length of all hospitalizations, the mean duration of hospitalization and the mean length of stay out of hospital. The independent variables were: age, sex, marital status, ethnic origin, diagnosis, and various indices of previous hospitalizations. For patients whose hospitalization in 1980 (index hospitalization) was the first in their life, older age and male gender predicted a low probability of readmission, and the diagnosis of schizophrenia a long cumulative stay. For patients whose index hospitalization was not the first in their life, the main variables predictive of long cumulative stay were: old age, being single, long duration and high frequency of previous hospitalizations. Patients tended to maintain the same relative length of inpatient stay and the same frequency of readmission from the beginning of their hospitalization history.
A system for identification and classification of the chronic mentally ill in the outpatient mental health sector is proposed, integrating three criteria: duration of illness, functional disability, and psychiatric diagnosis. Previous psychiatric hospitalization of a patient is used to determine their level of severity within the system. An example of the operationalism of these criteria is provided, along with validation of the system by using treatment and sociodemographic variables and indicators of the patient's level of functioning.
Military law does not invest doctors with the authority to determine whether a soldier is competent to enter military arrest. This determination is legal in nature. Therefore, medical (or psychiatric) examination which is carried out before or within military arrest or detention, is aimed at preventing deterioration in the health of the soldier in prison. Hence, medical opinion serves only as 'credentials' of sorts. This is the formal language of the military law. In reality, the examining psychiatrist has to consider many factors, bearing in mind that his conclusions will probably become a prominent basis for the final decision on the military legal officer (whether to enforce military arrest). In order to illustrate the complicated considerations which are set forth before military psychiatrists, several case reports are presented of soldiers, who were examined in the Israel Defence Forces central psychiatric clinic for the determination of competency for military arrest.
A survey of mental health knowledge, attitudes and help-seeking practices was conducted with 415 Soviet immigrants to Israel. The purpose of the study was two-fold: to provide data for mental health services and outreach programs designed for this immigrant group and to obtain a "proxy window" into these attitudes and behaviors in the Soviet Union itself. The results show that almost 20% of the immigrants reported consultation to formal agents in Israel and about half of these reported similar consultation in the USSR. An almost equal proportion consulted the family. Univariate and multivariate analysis show that demoralization, marital status, and religiosity were significantly associated with help-seeking. The second part of the survey explored Soviet immigrant attitudes to mental illness and the mentally ill by means of case vignettes and social situations, respectively. The respondents were able to detect abnormal behavior, but did not label it as psychopathology. Their overall tolerance of such behavior was low. These attitudes did not change over time nor seem to be influenced by reported abuses of psychiatry in the USSR.
Military law does not invest physicians with the authority to determine whether a soldier is competent when faced with military arrest, as this is a legal determination. Therefore, medical (or psychiatric) examination carried out before or during military arrest or detention, is aimed at preventing deterioration in the health of the imprisoned soldier. Hence, medical opinion serves only as a "credential" of sorts, the formal language of the military law. In reality, the examining psychiatrist has to consider many factors, including the probability that his conclusions will provide an important basis for the decision of the military legal officer as to whether to enforce military arrest. To illustrate the complicated considerations facing military psychiatrists, several case reports are presented of patients examined in the Israel Defence Forces central psychiatric clinic as to competency for military arrest.
A nationwide random sample of psychiatric patients (n = 832) admitted for hospitalization in Israel in 1980 was followed up until the end of 1984 regarding their hospitalization patterns. Information about hospitalizations as well as demographic and diagnostic data were obtained from the Israel Central Psychiatric Case Register. Two main contrasting patterns of hospitalization emerged. One pattern consisted of a single short hospitalization during the entire follow-up period. This pattern was found among more than 50% of those patients for whom this hospitalization was the first in their life. The second pattern characterized the patients who accumulated long periods of inpatient stay, that is, at least one year during the follow-up period. These are the "new chronic" patients (about 30% of the total sample). About one third of these "new chronic" patients (8.2% of the total sample) accumulated their long stay through one continuous hospitalization, thus resembling the "old chronic" patients; two-thirds accumulated their long stay over several hospitalizations. Each patient has a fairly constant pattern of hospitalization, regarding the length of stay in hospital and out of hospital.
This study examined standardized mortality ratios (SMR) among the patients who had undergone psychiatric hospitalization in Israel in 1978. The size of the sample (83,175 person-years) allowed us to calculate simultaneously SMR by age, sex, diagnosis and cause of death. The global SMR was 2.3 and decreased with age. Excess mortality was found in patients from all diagnostic groups for death from both natural and unnatural causes. Excess mortality from cancer was found only among patients aged under 40. The SMR for death by suicide was lower than that reported in the literature. The highest excess mortality was due to respiratory and infectious diseases in all groups and especially among young alcoholics and drug addicts (SMR = 273). This points to the importance of an ongoing follow-up of the physical health of psychiatric patients.