Search

Introduction: Stockholm syndrome (SS) is relatively rare, but during the 'Iron Swords' war, several cases were described in which some of the hostages showed identification and empathy with their captors, which presented their families and their caregivers with diagnostic and therapeutic questions. The term SS was coined following a robbery in Stockholm in 1973, after which one of the hostages developed a relationship with the captors. From this and other cases, SS has become a cornerstone in understanding the dynamics of extreme emotional fabric: trauma woven into the survival instinct. Risk factors for SS are described: being in absolute isolation from anyone other than the captor, inability to escape/avoid the situation, receiving gestures of kindness from the captor, all while the victims are under real threat to their physical and emotional integrity. Several theories for the development of SS exist: psychoanalytic theories rely on Ferenczi's concept of "identification with the aggressor," another theory speaks of 'cognitive dissonance' describing the discomfort arising from holding contradictory beliefs and attitudes. A third theory talks about a daily situation where the victims undergo "brainwashing". The fourth theory relies on an evolutionary perspective and speaks of a survival mechanism called conciliation/surrender. This theory emphasizes the survival goal of adapting to life-threatening situations through calming the aggressor and identifying with them. We found this explanation practical and most helpful for those suffering from this syndrome and their relatives. From understanding SS as a survival behavior, the therapeutic principle also arises. The important message in meeting with the returnees is to accept their emotional stance without judgment or anger and to normalize their behavior as a known and understood phenomenon. It is important to convey and mediate to the returnees and their families that this is a survival mechanism that indicates strength and resourcefulness.

Introduction: Pregnancy due to rape during captivity in female hostages is a complex, devastating and extremely challenging issue for victims, families and medical staff and may raise difficult ethical and clinical issues. Literature on the subject is scarce. Females who became pregnant as a result of rape in captivity in recent history, especially Yazidi women in ISIS captivity, suffered from a wide range of mental disorders including; post-traumatic stress disorder in high prevalence, anxiety, depression, severe dissociative disorder, somatoform disorder and sexual functioning disorders. Higher levels of education and the absence of prior mental disorders predicted better post-traumatic growth. It is crucial to prepare the medical staff to all possible scenarios including a potential refusal of the victim to opt for abortion due to emotional or religious reasons. It is extremely important to respect the victim's wishes and autonomy while avoiding paternalism or prejudice but at the same time offering consultation when confusion arises.

Introduction: Suicidal behavior among pre-adolescent children is a rare phenomenon so it is rarely studied compared to suicide at older ages. In recent years we have witnessed a disturbing increase in suicide rates among pre-adolescent children, an increase that requires our attention to the phenomenon through clinical observance, prevention and research. Most pre-adolescent children report suicidal thoughts rather than actual suicide attempts. The prevalence of suicide attempts increases after the onset of puberty. Early identification of pre-adolescent children who face suicidal risk will greatly contribute to early intervention and prevention of suicide in later years. In this article, we will review the clinical symptoms of suicidal behavior in pre-adolescent children, the epidemiology of the phenomenon, developmental issues, risk and protective factors, risk assessment, intervention, treatment and prevention.

Introduction: Psychiatry Department, Faculty of Medicine, Tel Aviv University, Israel The severe terrorist attack on Israeli civilians on 7th October 2023, with extreme cruelty and involvement of babies, children, women and elderly has special and unique characteristics and impact. The kidnapping of two hundred and forty-one citizens by the terrorists places the whole population in extreme and grave stress and fear. Learnings from the first few weeks of interventions with survivors is in line with the knowledge and assumptions from other mass trauma and disasters around the globe. Medical practitioners are first responders who are also exposed to the horrors seen in this extreme trauma event.

Introduction: The spread of epidemics resulting in many deaths has been known since the dawn of civilization, for example, the typhus and smallpox epidemics and the plague. Early in the previous century there was an outbreak of the Spanish Flue and towards the end of the 60's, the AIDS epidemic (HIV). Since the start of the current century, several epidemics broke out and spread to various places around the world, for instance, SARS (Severe Acute Respiratory Syndrome), the Avian Influenza and the Swine Influenza. In 2014 there was an outbreak of Ebola (Ebola virus disease) and in 2015 the Zika virus emerged and there were more. Epidemics cause havoc and impact all areas of life. Each epidemic takes an unfathomable price in lives. It is estimated, for example, that the AIDS epidemic took the lives of some 30 million people. The Corona virus (Covid-19) broke out in China, towards the end of 2019 and spread to most parts of the world. The implications of the outbreak are similar in many countries, among others, due to the uncertainty regarding the way the virus spreads, the appropriate treatment, the lack of vaccination and the high rate of deaths. Naturally, at such times physical protection is a top priority. However, coping with the implications to people's mental health is no less important and these may result in long-term negative impacts.

Introduction: In January 2020, the World Health Organization (WHO) declared an international emergency due to the outbreak of COVID-19. In March 2020 the WHO announced that the epidemic could be characterized as a pandemic. Subsequently, the WHO acknowledged the importance of providing support to the medical teams, realizing the enormous burden and stress facing this group. The aim of the present study is to review the up-to-date professional literature dealing with the psychological impact of a pandemic outbreak on medical staff. The literature existing so-far is scarce. It does, however, provide evidence of the short- and long-term impact of such epidemics on the mental health of the medical teams. Direct exposure to affected patients, the risk of contagion, a subjectively negative perception of one's medical condition and being in isolation or quarantine, all constitute risk factors for mental symptoms such as depression, anxiety and post-trauma. A sense of control, especially regarding the means of protection and controlling infection, altruistic acceptance of the work-related risks, social support, good team-spirit in the medical unit and support from superiors are all protective factors.

Introduction: Approximately a million people a year worldwide die by committing suicide. In Israel about 500 die by committing suicide. It is the leading cause of death in youngsters below the age of 24. More than half of them have met with their primary care physician (PCP) in the month prior to suicide. Suicide is more common in males and attempted suicide more common in females. Etiology is multifactorial and includes biological, genetic, psychological, social and environmental factors in a complex interaction. Major risk factors are male gender, psychopathology, prior suicide attempt, and accessibility to means for suicide. It is important that the PCP will ask directly on suicidal thoughts and urges in any case of suspicion. When the patient reports on suicidal thoughts or urges, it is important to create a safety plan to keep the patient safe including observation and restriction of means. It is important to treat depression early, maintain personal connections and continuity of care between hospital to PCP and mental health practitioners in the community. Early treatment of depression may save lives.

Schizophrenia in children and adolescents is a rare and serious representation of adult schizophrenia that indicates phenotypic and neurobiological continuity with the adult version of the illness. Epidemiological, genetic, cognitive and imaging findings support the centrality of the neuro-developmental model in the etiology of the disease. The diagnostic criteria for schizophrenia in children and adolescents, and in adults are identical. However, many of the children suffering from schizophrenia display higher levels of impaired pre-morbid functionality than adults with schizophrenia, and have a worse prognosis. Similar to adult-schizophrenia, prognosis is further worsened by frequent co-morbidities. Currently, treatment mainly consists of anti-psychotic medications, including clozapine. However, there is little evidence as to its effectiveness and side-effects are common in younger age.

Autism spectrum disorders (ASD) include several clinically different disorders. Despite the impression that in recent years there has been a rise in the incidence of this disorder, it seems that the apparent rise stems from the widening of diagnostic criteria rather than from a true rise in disorder incidence. Notwithstanding the wide range of clinical symptoms, reliabLe information on the etiology of this disorder is lacking. However, new data points to an important genetic component and to structural changes in the brain. There is a wide range of comorbidities with additional neurodevelopmental disorders. The currently offered treatment is multi-disciplinary and includes primarily behavioral therapy and symptomatic treatment with psychotropic drugs.

The first 5 years of life, the period called "early childhood", are characterized by a dynamic process of development and maturation of the central nervous system (CNS). This process is manifested by continuous changes in cognitive, motor, speech/language, psychological and sensory modulation skills and consequently, in the behavior of the developing child. It is a period of neuron-plasticity, in which the CNS structure and functioning are very sensitive to environmental influences. These influences could be positive or negative. On the one hand, early protective factors, like secure attachment, increase the resilience of the very young child against stressors and against the development of psychopathology; but on the other hand, there is a high vulnerability to early insults of any kind. It has been demonstrated that a high percentage of psychopathology in adult life has his roots in early childhood, and that early diagnosis, which leads to early therapeutic interventions, decreases morbidity and the later life consequences of the disorders. These findings have promoted the field of early childhood psychiatry during the last decade, to become one of the most promising challenges in the field of mental health. In our review, we present an update on the state of nosology, assessment and diagnosis in early childhood and provide clinical guidelines for the daily work of professionals involved in the mental health care of very young children.

Unlabelled: According to psychiatric classification, problems in effective socialization adjustment are characteristic of Pervasive Developmental Disorder (PDD), autism and Asperger syndromes. However, working in a clinic divulges a significantly sizable section of the population that faces problems in social functioning but does not fit either of the two aforementioned psychiatric diagnoses. Over the years a number of informal diagnoses have been developed for this group. The current literature reviews these diagnoses and deals with the question of whether these diagnoses are indeed different or whether they constitute a different viewpoint of the same problem. Some authors claim that the scarcity of current knowledge makes it impossible to provide a proper and precise answer. Therefore, the correct and effective approach is to integrate all the different viewpoints. Such an integrative approach may assist in better understanding the developmental socializing difficulties at a later time. In attempting to characterize the developmental socializing difficulties beyond the mere diagnoses, three major research viewpoints were developed while studying this group: the biological viewpoint, the missing central viewpoint and the behavioral viewpoint., Conclusions: It is important for the primary treating physician to show vigilance with regard to symptoms of impaired social functioning, especially in children and adolescents.

The rate of overweight people amongst schizophrenia sufferers is higher than it is in the general population and this is true even prior to starting drug treatment. It is well known that anti-psychotic medications increase the severity of weight control problems. It seems that weight gain is even more significant in adolescents than in adults. The mechanisms in those medications which cause weight gain are not well understood. Hormones like Leptin, Ghrelin and others are being investigated in relation to this issue. Various interventions, like weight loss medications, were investigated in adults suffering from schizophrenia but not in adolescents. Other weight loss interventions, for example behavior therapy, were also investigated in adults, both as preventive measures and as treatment for already present excessive weight. Even caloric limitation was attempted in closed adult wards. The majority of studies show that there is only a small loss of weight and the patients maintain their high Body Mass Index (BMI). Among adolescents suffering from schizophrenia it was found that weight gain results mostly from increase in caloric intake. The easy availability of processed foods and their relatively low cost, result in the positive caloric balance. During adolescence there is increased sensitivity to outer appearance, however, those youngsters have great difficulty following professionals' advice for a balanced diet. This is particularly hard for those adolescents who are treated with antipsychotics and suffer from increased appetite. In a comparative study of various weight loss treatments for children it was found that the most efficient one is group weight loss clinics intended strictly for parents. The efficacy of such group weight loss clinics for parents of schizophrenia suffering adolescents should also be investigated.

Anxiety disorders are the most common psychiatric illnesses in children and adolescents. They are associated with significant distress and impairment. Most of the children and adolescents with anxiety disorders are not detected and only a minority receives adequate treatment. Anxious children and adolescents often follow a chronic course of disease with elevated risk of depressive disorders, substance abuse and even suicide. Risk factors for anxiety disorders are complex and consist of intricate interplay of multiple factors, including genetic makeup and environmental risks. Effective, evidence-based treatments for anxiety disorders in children and adolescents consist of cognitive-behavioral therapy and pharmacotherapy with serotonin specific reuptake inhibitors. Further research is needed to design high-quality screening tools for anxiety disorders in the primary care setting.

Bipolar Disorder (BD) in children and adolescents is a known and well established disorder. Nonetheless, there are differing views about its main characteristics. Reliable information on the prevalence and incidence of the disorder is lacking, but it is known that there are recurrent episodes and psychiatric and psychosocial comorbidity. It is also known that there is a genetic predisposition for pediatric BD. Imaging research found pathology in some areas, but these findings are not BD specific. Effective treatment includes a combination of medications and different psychotherapies, including educational approaches. The recently described severe mood dysregulation syndrome (SMD) may also develop into BD.

Obsessive-compulsive disorder (OCD) in children and adolescents is a common, chronic familial disorder, which is associated with significant distress and disability. OCD is characterized by intrusive, repetitive thoughts or images (obsessions) that increase anxiety, and by ritualistic stereotyped behaviors or mental acts (compulsions) intended to neutralize the anxiety. In recent years there is growing evidence pointing towards the neurobiological basis of the disorder. OCD in children and adolescents is under-diagnosed and under-treated. A few simple screening questions may identify the children and adolescents suspected of having OCD and may lead to early detection and appropriate treatment. Effective, evidence-based treatments for OCD in children and adolescents include cognitive-behavioral therapy and pharmacotherapy with selective serotonin reuptake inhibitors.

Early onset depression is a widely prevalent, recurrent and familial disorder with a tendency to continue throughout adulthood. It is often accompanied by other comorbidities such as substance abuse, bipolar disorder, suicidal behavior and significant impairment in the child's psychosocial development. The risk factors include genetic, psychological and environmental factors and gene-environment interaction. The evidence-based therapies include cognitive, inter-personal and pharmacological interventions. Recently, the FDA published a warning concerning the use of these pharmacological agents in the pediatric age group. Further research is needed to assess the efficacy and safety of these interventions and to better understand the etiological factors.

Volatile substance abuse is a common and under-diagnosed disorder among young children and adolescents. The medical and psychiatric morbidity is high and dangerous. We reviewed the epidemiology, clinical features and damages to the various body systems of the child and his/her mental status. Recommendations for early detection and treatment approach are presented.

Suicide is the second leading cause of death among youths in many countries, and is a serious concern for public health. There are significant epidemiological differences between females and males--the "gender paradox". On the one hand, females report suicidal ideation more frequently, and attempt suicide more often. On the other, boys exceed females in the rates of suicidal deaths. Although many studies have been conducted to identify the risk factors for suicidal behavior, these have not focused on gender differences. In this review we examine the differences between suicidal females and males, in childhood and adolescence, as well as in adults. We review the gender differences concerning risk factors that have been linked to suicidal behavior. We also relate to the gender dependent social attitude toward suicidal behavior. Identifying the risk factors for suicidal behavior for each gender separately will help us understand, why girls try to commit suicide more often, but are relatively protected from dying from such acts, and the opposite is relevant for boys. This discussion is vital for the development of suicide prevention programs.

Somatization disorder in children and adolescents is a common anxiety disorder. Errors and delays in diagnosis may incur unnecessary expensive and sometimes dangerous medical workup. We review the epidemiology, clinical features, treatment approaches and prognosis. One case study is presented in order to demonstrate this problematic disorder.