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Aims.To examine changes in service utilisation before, during and after the 2006 Lebanon War – a 34-day military conflict in northern Israel and Lebanon – among three groups: general population, people ‘at risk’ for depression or anxiety and severely mentally ill individuals. Given that exposure to traumatic events is a pathogenic factor known to cause and exacerbate psychiatric distress and disorder, we hypothesised that healthcare service utilisation would increase in populations exposed to war, especially among more vulnerable populations such as those with mental illness.Method.A nested case–control design was used to examine changes in health care utilisation and use of psychiatric medication as recorded by the databases of Maccabi Healthcare Services (MHS), one of Israel's largest health maintenance organisations (HMOs). Purchases of benzodiazepines, antidepressants and antipsychotic medications were identified from all the medications purchased in pharmacies by MHS members during 2006. Drug consumption data were expressed as defined daily doses (DDDs), summing all DDDs per person per month. Similarly, number of visits to general practitioners (GPs), psychiatrists and Emergency Rooms (ERs) were summed per person per month. Three-way repeated measures ANOVA was used, including the variables time (12 months), region (north/other) and study group.Results.During the war there was a decline in GP visits among people from the general population and people ‘at risk’ for depression/anxiety who resided in northern Israel that was not paralleled among controls. Similarly, in all three study groups, there was a decline in the number of psychiatrist visits during the war among people from northern Israel which did not occur to the same extent in the control group. There were no changes in ER visits or use of psychiatric medication that could be attributed to the war.Conclusions.There is less utilisation of community services at times of war among exposed populations, and there is neither evident compensation in use of emergency services, nor any compensation after the war. This may suggest that if there is an efficient medical and mental health infrastructure, people with or without psychiatric risk factors can tolerate a few weeks of a mass stress event, with no need to expand medical service utilisation. However, service utilisation at times of war may be confounded by other variables and may not serve as a direct measure of increased stress.

The implications of the chemical war threat and the missile attacks during the Gulf War for a medium-sized psychiatric community are analyzed in terms of psychiatric care and management. Changes in medication, physical restraint, and ward transfer were observed for schizophrenic patients inactive psychoticphase (n=50), inresidual post-activephase (n=37), and patients with long-termresidual type (n=167). The variables for the first week of the war (n=250) were compared to those the same week 1 year before (n=254). Patients in active phase and patients in residual phase received more supplementary treatment and radical changes in treatment; patients in active phase received more treatment reinforcement, as well as physical restraint, compared to patients in residual phase and residual type patients. Residual type patients remained unchanged on all variables. Residual type patients remained mostly indifferent, while many severely disturbed psychotics needed restraining and less severely disturbed patients residing in open wards required only minor tranquilizers. Patients in active phase tended to behave very erratically while denying being affected by the war, and patients in residual phase overtly expressed their anxiety and remained in control.

A pilot open study was conducted in order to evaluate the efficacy of clonidine in the treatment of LSDinduced hallucinogen persisting perception disorder HPPD. Eight patients fulfilled entrance criteria. All complained of HPPD for at least 3 months and were drug free at least 3 months. They received fixed low doses of clonidine, 0.025 mg, three times a day for 2 months. They were evaluated by the Clinical Global Impression Scale CGI and a selfreport scale on the severity of symptoms graded 05. Patients scored an average of 5.25 SD 0.46 on the CGI and 4 on the selfreport scale at baseline, indicating marked psychopathology. One patient dropped out at week 3 and a second patient dropped out at week 5. Of the six patients remaining at the end of 2 months, the average CGI score was 2.5 SD 0.55 and the selfreport scale score was 2, indicating mild symptomatology. LSDrelated flashbacks associated with excessive sympathetic nervous activity may be alleviated with clonidine in some patients.

The ongoing shelling of missiles on the city of Sderot in Israel for the past 8 years have caused damage in terms of life and property as well as have put more than 25,000 residents under significant and ongoing threat. A recent study examining the impact of living under these conditions has revealed that 28.4% of the area residents suffer from PTSD and 75%???94% of the children reported to experience posttraumatic symptoms (Gelkopf, Berger, Bleich, Cohen, submitted). Despite the psychological needs of the residents, mental health service utilization has been sparse due to many residents not feeling safe to leave their homeland fear the stigmatization in attending public mental-health clinics. In order to resolve this dilemma, we have developed a community home-based family intervention delivered through a mobile unit of professionals who provide mental-health services for to traumatized families in their homes. The model incorporates family systemic approach with trauma-focused cognitive-behavioral technique and narrative strategies. I will outline the model and present an evaluation of its efficacy in reducing PTSD and in improving daily functioning in adults and children. I will also describe several cases illustrating the model. Finally, we conclude that such a model may be useful in providing mental-health services in major disaster, such as Tsunamis, earthquakes and floods, particularly in developing countries where mental health capacity is limited and where local populations will not always have the means or be able to reach clinics.