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Background The Israel Mental Health Act of 1991 stipulates a process for involuntary psychiatric hospitalization (IPH). A patient thus hospitalized may be discharged by either the treating psychiatrist (TP) or the district psychiatric committee (DPC). The decision rendered by the DPC is often at odds with the recommendation of the TP. Although much has been written about the ethical issues of restricting patients’ rights and limiting their freedom, far less attention has been devoted to the psychiatric, medical, and social outcome of legal patient discharge against the doctor’s recommendation. Methods In our study we examined the outcomes of the decisions made by the DPC using readmission data, an internationally recognized indicator of the quality of hospital care, and compared them to the outcomes of patients discharged by the TP. All IPH discharges resulting from the DPC’s determination for the year 2013 (N = 972) were extracted from the Israel national register. We also collected all IPH discharges owing to the TP’s decision for 2013 (N = 5788). We defined “failure” as readmission in less than 30 days, involuntary civil readmission in less than 180 days, and involuntary readmission under court order in less than 1 year. Results The rehospitalization pattern was compared in the two groups of patients discharged from their psychiatric hospitalization during 2013 (index discharges) and followed up individually for a year. We found a statistically significant difference between the DPC and the TP group for each of the time frames, with the DPC group returning to IPH much more frequently than the TP group. Using cross-sectional comparison with logistic regression adjusted for age, gender, diagnosis and length of hospitalization, we found the probability of a decision failure in the TP group was significantly less with an OR of 0.7 (95% CI .586–.863), representing a 30% adjusted decrease in the probability for failure in the TP group. Conclusions The results we present show that the probability of decision “failure” (readmission) was found to be significantly higher in the DPC group than in the TP group. It is often assumed that IPH patients will fare better at home in their communities than in a protracted hospitalization. This is frequently the rationale for early discharge by the DPC (30.1 days vs. 75.9 DPC and TP groups, respectively). Our results demonstrate that this rationale may well be a faulty generalization.

There is scant research on the psychopathology of Israeli soldiers who present to a general hospital emergency department (ED).To assess the psychopathology among a cohort of Israeli soldiers who presented to a general hospital ED for mental health assessment.The demographic and clinical characteristics of 124 consecutive soldiers who presented to the ED for psychiatric assessment between January 2008 and September 2012 were reviewed. Twenty-seven soldiers from the cohort were contacted for follow-up by telephone on average 52 months later.The reasons for presentation to the ED, usually during the early stages of military service, included self-harming behavior, suicidal ideation, somatoform complaints, and dissatisfaction with their military service. Psychiatric diagnoses included adjustment disorder and personality disorder. Self-harming behavior/suicidal ideation was significantly correlated with unspecified adjustment disorder (P = 0.02) and personality disorder (P = 0.001). At follow-up, there was a lack of substantial psychopathology: none of the subjects engaged in self-harming behavior/suicidal ideation and a consistent trend was observed toward clinical improvement.Psychiatric intervention of soldiers who present to a general hospital ED because of emotional difficulties may provide the opportunity for crisis intervention and validation of the soldier's distress. To the best of our knowledge this is the first Israeli study of psychopathology among soldiers who presented to an ED.

To compare the mental health status of those who participated in combat related activities during their service with that of soldiers whose army service did not include combat related activities Method: A representative sample extracted from the National Population Register of non-institutionalized residents aged 21 or older of Israel was used in this crosssectional survey. Data on mental health disorders, sociodemographic background and army service were collected using face-to-face computer-assisted interviews.Combat experience per se was not associated with lifetime diagnosis of PTSD. Former combat soldiers had significantly lower lifetime prevalence and 12 months prevalence of any mood or anxiety disorders including PTSD.This work is in line with previous literature showing that combat exposure, as such, has limited contribution to lifetime PTSD in some groups of veterans. The inverse relationship between combat exposure and PTSD might be explained by the selection of potential combatants among all recruits and by the heightened preparedness to military life stressors.

From Flugelman (Mazra) Psychiatric Hospital, Doar Na Ashrat, Israel (HS, IB, NJ); and the Department of Psychiatry, Rivka Zeiff Hospital, Zefal, Israel (NO, AM). Address reprint requests to Dr. Henry Silver, Psychiatric Hospital, Flugelman (Mazra), Doar Na Ashrat 25201, Israel. Received January 6, 1995; revised July 21, 1995. throughout. Fluvoxamine was added to this treatment. Five patients received 50 mg and 3 patients 100 mg throughout the study. In 3 patients the dose was increased from 50 to 100-150 mg during the study. Clinical state was assessed every 1-2 weeks with appropriate scales. A single blood sample was taken at 0800 hours, before the morning dose of medication. Sampling was performed prior to and after 1, 3, 5, 7, and 8 weeks of treatment. The study was conducted in the winter months from November to early January. Blood was centrifuged within an hour of collection, and plasma was collected and stored at -70°C until analysis. Melatonin was assayed using enzyme immunoassay (EIA) kits (Buhlmann Laboratories AG, Switzerland; Code EKMEL), utilizing a capture second antibody technique (Claustrat et al 1990; details available from authors). Blood samples were assayed at least three times without dilution and at different dilution rates for linearity estimation. All assays were done in triplicate. Quality controls included control for day-to-day variation, and control of optic density (OD) at zero standard and three different standard concentrations within every assay run. For variation coefficient calculation we used a control internal sera