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Objective: This brief report presents a staff training program based on psychiatric rehabilitation principles used in a hospital setting. The training program intervention significantly promoted the belief that mental illness does not necessarily limit functioning and also improved awareness of research findings, evidence-based practices and community services., Methods: A randomized controlled study assessed the impact of the program on the staff's attitudes regarding psychiatric rehabilitation and recovery., Results: Findings suggest that in-service training programs within a hospital setting can change staff attitudes in order to support psychiatric rehabilitation., Conclusions: A psychiatric rehabilitation forum, made up of representatives from all disciplines, including the medical directors of every ward, was set up in the hospital following the training program and has become the main avenue to disseminate information, messages, and goals to the staff at large and to the hospital administration. It is the forum that creates the shared vision about psychiatric rehabilitation within the hospital and has the task of facilitating implementation of services according to that vision.

Unlabelled: Pruritus is an annoying physical symptom, frequently related to mental states. Dermatologic treatment commonly includes psychotropic medications., Aims: This study aimed to investigate idiopathic pruritus (IP) in psychiatric patients, its demographic characteristics and its relationship to psychiatric diagnoses, psychosocial stress, medication use, drug use and psychological characteristics., Methods: The study population included 100 psychiatric inpatients. Study data were acquired by means of structured patient interview using standardized questionnaires., Results: IP was experienced by 42% of the subjects, 34% of the men and 58% of the women (P=.03). The presence of IP was found to be related to psychosocial stress with a prevalence of 48.5% among those without adequate social support and 29.5% among those with adequate social support (P=.02) and with a prevalence of 48.5% of those without regular employment and 16.7% among subjects who were employed (P=.01). A trend of reduced prevalence of IP (14%) was found among patients treated with tricyclic antidepressants compared with 48% of those treated with other antidepressants (P=.09). No significant correlation was found with other medications or psychiatric diagnoses. IP was found in 76% of regular users of opioids. IP was more frequent in patients with higher scores on the anger-trait measure (P=.02) and on the angry temperament measure (P=.02) and ruminative catastrophization (P=.04)., Discussion: The high incidence of itching among psychiatric inpatients necessitates awareness of the treating psychiatrist to this potential discomfort. Examination, diagnosis and treatment when needed can relieve the physical symptoms, which may also have an emotional effect on the patient.

A school-based intervention for preventing and reducing children's posttraumatic stress-related symptoms, somatic complaints, functional impairment, and anxiety due to exposure to terrorism was evaluated. In a quasi-randomized controlled trial, elementary school students were randomly assigned to an eight-session structured program, "Overshadowing the Threat of Terrorism" or to a waiting list control comparison group. Two months postintervention, the study group reported significant improvement on all measures. The authors conclude that a school-based universal intervention may significantly reduce posttraumatic stress disorder- (PTSD-) related symptoms in children repeatedly exposed to terrorist attacks and propose that it serve as a component of a public mental health approach dealing with children exposed to ongoing terrorism in a country ravaged by war and terrorism.

Aims: We assessed the interest of psychiatric inpatients and the staff in a smoking reduction program., Methods: Inpatients, nurses, social workers and psychologists at a university-affiliated psychiatric hospital completed questionnaires addressing attitudes towards smoking and the desire to reduce smoking., Results: 52% of the inpatients (N = 160) and 37.3% of the staff members (N = 41) reported that they smoked. Mean number of cigarettes for patients was 21.4 cigarettes per day for men, and 18.8 for women; 74 patients (46.2% of the smokers) and 96 staff members (88% of the smokers) expressed interest in participating in a smoking reduction program. No correlation was found between the rate of smoking among the staff and the rate of smoking of the patients in any given department., Conclusions: Psychiatric inpatients and their caregivers who smoke are interested in reducing the number of cigarettes that they smoke. Further study regarding the initiation of therapeutic smoking reduction programs in inpatient settings is warranted.

Background: Israeli citizens have been exposed to intense and ongoing terrorism since September 2000. We previously studied the mental health impact of terrorism on the Israeli population (Bleich et al., 2002), however the long-term impact of ongoing terrorism has not yet been examined. The present study evaluated the psychological sequelae of 44 months of terrorism in Israel, and sought to identify factors that may contribute to vulnerability and resilience., Methods: This was a telephone survey using strata sampling of 828 households, which reached a representative sample of 702 adult Israeli residents (84.8% contact rate). In total, 501 people (60.5%) agreed to participate. The methodology was similar to that of our previous study. Exposure to terrorism and other traumatic events, number of traumatic stress-related symptoms (TSRS), percentage of respondents with symptom criteria for post-traumatic stress disorder (PTSD), traumatic stress (TS) resiliency and feelings of depression, anxiety, optimism, sense of safety, and help-seeking were the main outcome measures., Results: In total, 56 participants (11.2%) were directly exposed to a terrorist incident, and 101 (20.2%) had family members or friends exposed. Respondents reported a mean +/- SD of 5.0 +/- 4.5 TSRS; 45 (9%) met symptom criteria for PTSD; and 72 (14.4%) were TS-resilient. There were 147 participants (29.5%) who felt depressed, 50 (10.4%) felt anxious, and almost half (235; 47%) felt life-threatening danger; 48 (9.7%) felt the need for professional help. Women and people of Arab ethnicity had more TSRS, more PTSD, and less TS resiliency. Injury following a life-threatening experience, a major stressful life event, and a major loss of income were associated with PTSD. Immigrant status, lower education, low sense of safety, low sense of social support, high societal distress, and injury following life-threatening experiences were associated with TSRS. TSRS did not increase with exposure severity. This study revealed less depression and functional impairment, similar rates of PTSD, increased help-seeking and poorer TSRS and TS resiliency than our initial study, 2 years previously., Discussion: The response of people in Israel to 4 years of terrorism is heterogeneous. Vulnerability factors change over time; Arab ethnicity, immigrant status and less education, not found to be risk factors in our previous study, were found in the present study to contribute to trauma-related distress. Prior experience of highly stressful events increases vulnerability to adverse psychological effects of terror.

Objective: The influence of psychiatric comorbidity in drug addicts on therapeutic outcome is an important unresolved issue. We studied the links between patterns of psychiatric comorbidity and psychological distress with treatment outcome variables., Method: 151 methadone maintenance patients underwent a structured clinical interview, twice-weekly urinalysis for traces of drugs of abuse, and completed psychological distress and risk-taking questionnaires for periods of up to three years. Treatment tenure, demographics and hepatitis C status were recorded., Results: High levels of lifetime (82.8%) and current (66.2%) Axis I psychiatric comorbidity were mostly anxiety and affective disorders many of which were substance induced. Patients with current psychiatric comorbidity had significantly more current substance use disorders, although they did not abuse more drugs or remain in treatment less time than patients with no current psychiatric comorbidity. Patients with a lifetime Axis 1 disorder remained in treatment longer. Severity of psychological distress was related to current substance-related diagnoses, benzodiazepine abuse, higher methadone dosage, risk-taking behavior and the presence of hepatitis C., Conclusions: Severity of psychological distress, but not comorbid psychiatric disorders, has a major negative association with treatment outcome of patients receiving methadone maintenance treatment (MMT). Surprisingly patients with comorbid mental illness seem to remain in treatment longer than those without. Therapeutic efforts should also focus on treating subjective distress and its possible influence upon drug use behavior.

Objective: This study examines gender differences in posttraumatic vulnerability in the face of the terror attacks that occurred during the Al-Aqsa Intifada. In addition, the contribution of level of exposure, sense of safety, self-efficacy, and coping strategies is assessed., Method: Participants were 250 men and 262 women, who constitute a representative sample of Israel's adult population. Data were collected via a structured questionnaire consisting of 51 items that were drawn from several questionnaires widely used in the study of trauma., Results: The findings indicate that women endorsed posttraumatic and depressive symptoms more than men and that, generally, their odds of developing posttraumatic stress symptoms are six times higher than those of men. Results also revealed that women's sense of safety and self-efficacy are lower than men's and that there are gender differences in coping strategies in the face of terror., Conclusions: Gender differences in vulnerability to terror may be attributable to a number of factors, among these are women's higher sense of threat and lower self-efficacy, as well as their tendency to use less effective coping strategies than men. Level of exposure to terror was ruled out as a possible explanation for the gender differences in vulnerability.

Objective: Since September 2000, continuous terrorist attacks have exposed Israeli society to trauma, and the impact of these events on the mental health of the elderly Israeli population remains unclear. The authors sought to assess the prevalence of posttraumatic stress-related symptoms of distress, depression, optimism, self-efficacy, and sense of safety of the young-old and old-old Jewish population after 19 months of intense terrorism in Israel, in order to identify correlates of the psychological sequelae and compare symptoms and coping methods of these populations with those of younger adults., Methods: Authors did a telephone survey using stratified sampling with a national sample of young-old (65-74 years old), old-old (>74 years old) and a comparison group of younger adults (18-64 years old)., Results: No difference was found in the level of exposure, traumatic stress symptoms, including probable PTSD, except for a nonsignificant tendency toward more depersonalization and emotional numbness in the elderly group, a tendency toward more sleeplessness, more re-experiencing of unwanted thoughts, hyperarousal, fewer avoidance symptoms, and less disengagement-coping in the old-old group. Younger adults were found to be significantly more optimistic. Young-old and old-old people used cigarettes/alcohol and tranquilizers more often to cope with the situation, and old-old people who used disengagement-coping felt less helped by it., Conclusions: Young-old and old-old people do not differ significantly from the younger adult population with regard to their response to 19 months of intense and recurrent terrorism.

The concept of Mental Homelessness is presented and developed. This paper will provide a historical review of the connection between mental illness and housing and the changing approaches toward institutionalization and de-institutionalization over several centuries. Case illustrations from practice in Israel will be presented to highlight the theme of home, or rather the theme of lacking a home as an element which may be inherent to a mental illness. More specifically, the paper argues that homelessness is a state of flection of. If so, even if a mental patient does initially own a home, he or she is at high risk to lose it somehow. This work is a primary attempt at developing a new idea, stemming originally from the field of mental health, with an attempt to widen its theoretical scope to populations not usually defined as mentally ill. Clinical characteristics are presented, as well as an attempt at a theoretical formulation of this concept permitting the development of therapeutic implications. These are presented in relation to existing psychodynamic concepts and therapeutic approaches related to the phenomenon of homelessness. mind of which the actual, physical homelessness may be a manifested re.

Objective: We addressed the following questions. What are the current and lifetime prevalence of cannabis abuse in an Israeli methadone maintenance treatment (MMT) clinic? Does cannabis abuse change over time during MMT? Is cannabis abuse related to treatment outcome measures such as retention rate and the abuse of drugs? Is the abuse of cannabis related to psychopathology, HIV/HCV risk-taking and infectious diseases? Do cannabis abusers (CAs) have a different psychosocial and demographic profile than nonabusers (NCAs)? Is cannabis abuse part of a polydrug abuse tendency or a distinct substance of abuse?, Method: Overlapping samples of either the entire clinic population (n = 283) or all the patients who had completed 1 year of MMT treatment (n = 196 of which 20 were re-entering) underwent random and twice-weekly observed urine analysis for various drugs of abuse, responded to self-report questionnaires (SCL-90-R; HIV/HCV risk-taking behaviours; n = 164), interviews (ASI, n = 176; SCID, n = 151) and hepatitis C and HIV testing (n = 149)., Results: Lifetime abuse prevalence was found in 75% and current abuse at MMT intake in 25%. Abuse did not increase significantly over a 1-year period. Cannabis abusers were found to be more often polydrug abusers than NCAs. Cannabis abusers did not suffer from more psychological distress, infectious diseases, and did not engage in more HCV/HIV risk-taking behaviour, nor did they leave treatment earlier than NCAs., Conclusions: Cannabis abuse MMT patients should be treated as polydrug abusers, although no specific influences of cannabis abuse on psychological and medical conditions of MMT patients have been observed. Treatment policy should take these results into consideration.

An out-of-body experience (OBE) is a unique dissociative event in which the person feels separated from his/her body. Studies and anecdotal reports have observed that this experience tends to appear spontaneously in stressful and hypnogogic situations. It often contributes to the person's later having a new perspective of himself and his conception of the world, and may influence his functioning and behavior. Despite its potential as a powerful therapeutic lever in hypnotherapy, little has been written about applying OBE in this milieu. The current article describes three individuals who were contending with different therapeutic issues (i.e., symbiotic involvement, somatization, and cessation of therapy) for whom spontaneous OBE was used therapeutically during hypnotherapy and proved to significantly advance the therapeutic processes. In accordance with the literature, and as observed in the presented cases, we have found that the OBE experience tends to appear in dissociative and highly suggestible subjects. Furthermore OBE may help those patients to cope with strongly anxiety-loaded issues that arise in therapy and may function, through the "body-self" detachment experience, as a therapeutic metaphor for promoting complex separational processes. In view of the cases described, a spontaneous OBE appearing in hypnotherapy is proposed as an effective therapeutic resource.

Context: The terrorist attacks on Israeli society have been ongoing since September 2000. However, few studies have examined the impact of terrorism on nationally representative population samples, and no study has examined the psychological impact of ongoing terrorism in Israel., Objectives: To determine the level of exposure to terrorist attacks and the prevalence of traumatic stress-related (TSR) symptoms, symptoms of posttraumatic stress disorder (PTSD), and sense of safety after 19 months of terrorism in Israel, and to identify correlates of the psychological sequelae and the modes of coping with the terrorism., Design, Setting, and Participants: Telephone survey conducted April-May 2002, using a strata sampling method, of 902 eligible households and a representative sample of 742 Israeli residents older than 18 years (82% contact rate) and a final participation of 512 (57%)., Main Outcome Measures: Number of TSR symptoms, rates of those with symptom criteria for PTSD and acute stress disorder assessed by the Stanford Acute Stress Reaction Questionnaire, self-reported feelings of depression, optimism, sense of safety, help-seeking, and modes of coping., Results: Of 512 survey participants, 84 (16.4%) had been directly exposed to a terrorist attack and 191 (37.3%) had a family member or friend who had been exposed. Of 510 participants who responded to questions about TSR symptoms, 391 (76.7%) had at least 1 TSR symptom (mean, 4.0 [SD, 4.5]; range, 0-23; mean intensity, 0.8; range, 0-4). Symptom criteria for PTSD were met by 48 participants (9.4%) and criteria for acute stress disorder, by 1 participant; 299 (58.6%) reported feeling depressed. The majority of respondents expressed optimism about their personal future (421/512 [82.2%]) and the future of Israel (307/509 [66.8%]), and expressed self-efficacy with regard to their ability to function in a terrorist attack (322/431 [74.6%]). Most expressed a low sense of safety with respect to themselves (307/509 [60.4%]) and their relatives (345/507 [67.9%]). Few reported a need for professional help (27/506 [5.3%]). Female sex, sense of safety, and use of tranquilizers, alcohol, and cigarettes to cope were associated with TSR symptoms and symptom criteria for PTSD; level of exposure and objective risk were not. The most prevalent coping mechanisms were active information search about loved ones and social support., Conclusions: Considering the nature and length of the Israeli traumatic experience, the psychological impact may be considered moderate. Although the survey participants showed distress and lowered sense of safety, they did not develop high levels of psychiatric distress, which may be related to a habituation process and to coping mechanisms.

Objective: Therapeutic approaches for benzodiazepine (BZD) dependence in patients in methadone maintenance treatment (MMT) have met with limited success. Clonazepam detoxification (CDTX) and clonazepam maintenance treatment (CMT) were compared in an open, clinical naturalistic study on such patients., Methods: Benzodiazepine dependent patients substituted their BZD of abuse for clonazepam and were then either detoxified (CDTX) or a maintenance dose was reached and maintained (CMT). Patients were considered as failing the trial if they either abused BZDs (CDTX group) or abused BZDs over the maintenance dose (CMT group). Treatment outcome was evaluated based upon self and staff reports over 1 year after beginning treatment. Axis I and II psychiatric diagnosis was assessed and methadone dosage and history of abuse was recorded., Results: In the CDTX group, 9/33 (27.3%), were BZD-free after 2 months. In the CMT group, 26/33 (78.8%) refrained from abusing additional BZDs over the maintenance dose after 2 months. The same success rate remained over the entire year. Survival analysis showed CMT to be more successful than the CDTX. Axis I psychiatric comorbidity was found to be positively related to treatment success in the CMT group while axis II antisocial personality disorder was found to be negatively related to treatment success in that group. It had no impact in the CDTX group., Conclusions: Maintenance strategy with clonazepam is a useful BZD treatment modality for BZD-dependent MMT patients with a long-term history of abuse and previous attempts at detoxification. Psychiatric comorbidity may have an important role in choosing the adequate treatment modality and influencing treatment outcome.

A double-blind, placebo-controlled crossover study was undertaken in 10 neuroleptic-treated male schizophrenic outpatients to assess the effect of coadministration of selegiline 15 mg/day for 3 weeks on their sexual dysfunction. Selegiline was not found to be effective in improving any domain of sexual functioning despite a significant decrease in prolactin levels (P < 0.05). This study emphasizes the complex nature of sexual dysfunction in schizophrenic-treated patients and the need for placebo-controlled trials for this condition.

An unique and intriguing characteristic of lysergic acid diethylamide (LSD) and LSD-like substances is the recurrence of some of the symptoms which appear during the intoxication, in the absence of recent intake of hallucinogens. Hallucinogen persisting perception disorder (HPPD) is a condition in which the re-experiencing of one or more perceptual symptoms causes significant distress or impairment in social, occupational or other important areas of functioning and may be extremely debilitating. Benzodiazepines are one of the recommended agents for the treatment of HPPD but it is unclear which of them may be more helpful. The goal of our investigation was to assess the efficacy of clonazepam in the treatment of LSD-induced HPPD. Sixteen patients fulfilled entrance criteria. All complained of HPPD with anxiety features for at least 3 months and were drug free at least 3 months. They received clonazepam 2 mg/day for 2 months. Follow-up was continued for 6 months. They were weekly evaluated during the 2 months of clonazepam administration and monthly during the follow-up period using the Clinical Global Impression Scale, a Self-report Scale and Hamilton Anxiety Rating Scale. Patients reported a significant relief and the presence of only mild symptomatology during the clonazepam administration. This improvement was clearly sustained and persisted during a 6-month follow-up period. This study suggests that high potency benzodiazepines like clonazepam, which has serotonergic properties, may be more effective than low-potency benzodiazepines in the treatment of some patients with LSD-induced HPPD.

The two models which have most affected theory and practice of addiction medicine have been the disease model and the self-medication hypothesis. The disease model's fundamental concept is that the addicted individual is sick and suffers from a disease. The self-medication hypothesis proposes that drug and alcohol users are attempting to cope with an underlying psychological or social disorder by means of self-medication. These two viewpoints are presented in the light of a number of specific methadone maintenance treatment and drug abuse related issues such as the question whether drug abuse is an illness of the body, the mind or society; whether the disease model really de-stigmatized drug abuse; what the correct methadone dosing policy should be; the place of psychotherapy in methadone maintenance treatment and drug abuse and how polydrug abuse should be treated. These issues are discussed and an integrated approach is suggested stressing the need for social criticism and a renewed social policy towards drug abuse in general and its treatment in particular.

Objective: 1) To study the prevalence, course and correlates of benzodiazepine (BZD) abuse in an Israeli methadone maintenance treatment (MMT) clinic; and 2) to present preliminary results of an open clinical study on the treatment of BZD addiction in MMT patients using BZD maintenance., Methods: Study 1 was carried out on 196 patients who were in MMT for at least one year. Objective information on drug use (urine testing) was recorded, and the one-year retention rate was measured. Demographic data and history of abuse were obtained, and a self-rated psychopathology and psychological distress questionnaire was administered. The second study was an open one. Twenty BZD-addicted patients were given clonazepam maintenance treatment (CMT) and were started on a daily regimen of 6 mg. followed by a gradual tapering until an individual dose was reached. This maintenance dose was the lowest level at which the patient still expressed satisfaction with the BZD dose without reporting craving or overdose. Failure was defined by three daily consecutive BZD uses above the permitted dose., Results: BZD abuse was significantly reduced during the first year of MMT (from 55 to 43%, P < .000), although a number of patients started to abuse BZDs during this period. BZD abusers (BAs) were found more often to be polydrug abusers, their methadone dosage was higher than non-abusers (NBAs), they started to abuse drugs in general and heroin in particular earlier than NBA, and they had higher self-rated psychopathology and psychological distress scores. The second study showed that CMT was successful in 75% of the patients over a period of six months and that it is, therefore, a promising mode of treatment for BZD-dependent MMT patients., Conclusions: MMT patients who abuse BZDs are at an increased risk for continuing polydrug abuse. Although our results are to be taken cautiously due to the inherent limitation of a non-controlled non-randomized pilot study, ongoing maintenance with clonazepam seems to be well tolerated and a stabilizing and satisfying pharmacotherapy for BZD dependent MMT patients.

One unique characteristic of lysergic acid diethylamide (LSD) and LSD-like substances is the recurrence of some of the symptoms which appeared during the intoxication after the immediate effect of the hallucinogen has worn off. This recurring syndrome, mainly visual, has not been clearly understood, appreciated or distinguished from other clinical entities by clinicians. The terms Flashback and Hallucinogen Persisting Perception Disorder (HPPD) are used interchangeably in the professional literature. Flashback is a usually short-term, non-distressing, spontaneous, recurrent, reversible and benign condition accompanied by a pleasant affect. In contrast, HPPD is a generally long-term, distressing, spontaneous, recurrent, pervasive, either slowly reversible or irreversible, non-benign condition accompanied by an unpleasant dysphoric affect. Flashback and HPPD appear to be part of a vast and broad spectrum of non-psychopathological and psychopathological states reported by hallucinogen users. Pharmacological agents such as clonidine, perphenazine and clonazepan have been shown to ameliorate this syndrome in some of the individuals seeking treatment.

Since many methadone maintenance treatment (MMT) clinics in the United States do not share with patients, information concerning their methadone dosage, we aimed to investigate the impact of patients being informed of their methadone dosage and the influence of ending blind dosing on treatment outcome. Seventy-four patients who were unaware of their methadone dosage took part in this study. We compared changes in opiate abuse, levels of methadone dosage and patients' perceptions of dosage adequacy before and after they were informed of their dosage. Data on opiate abuse were based upon bi-weekly randomly taken and observed urine tests provided the data on opiate abuse. Records on methadone dosage were kept and a short questionnaire on dosage-related attitudes, devised for this study, was administered. Most patients expressed the desire to know their dosage, but there were no significant changes in opiate abuse, methadone dosage or the patients' perceptions of dosage adequacy after they knew what it was. We conclude that informing patients of their methadone dosage and thereby ending blind dosing does not seem to have any negative effect on treatment outcomes. We believe that this policy is in accord with the patients' rights and expressed will to know their dosage and this justifies putting an end to blind dosing policies.

The study examined whether closing of a methadone maintenance clinic in Israel on the Sabbath was associated with adverse patient outcomes. One take-home dose of methadone was given to all patients for that day regardless of whether they had earned take-home privileges. No difference was found in dropout rates for the six-month periods before and after Saturday closure was initiated. Results of random, twice-weekly urinalyses for all patients did not indicate increased use of heroin. The findings suggest that closure of a methadone clinic at least one day a week does not jeopardize patient outcome. Cutting hours of operation would reduce workload and enable clinics to function more economically.

The psychiatric and judicial concepts of mental disorders are similar but not always identical. The gap between them creates confusion, a lack of unity and inconsistencies in decision making. This gap needs to be bridged. In the hinterland of these concepts lies a range of psychiatric disturbances such as encapsulated over organized delusional disorders (Paranoia Vera) and life endangering eating disorders (Anorexia Nervosa). When life threatening or criminal responsibility circumstances arise, the dilemma presented to the psychiatrists on the one hand and the judicial system on the other reaches its peak. Presented in the article are aspects of the gray areas of involuntary commitment and criminal responsibility.

We attempted to use passive communal laughter to improve social support within a chronic schizophrenic inpatient population. Two identical wards were compared on classical measures of social support (emotional and functional), social network (size and dispersion), satisfaction, and the nature of the social relationships (source). The experimental group was exposed to video projection of humorous movies four times daily for 3 months, and the control group to video projections of other, assorted movies at the same rate. In the experimental ward a significant improvement was manifest in the category of "distinct individuals supporting each patient." The difference may have been due to an improvement in the relationship with the staff. No improvement was found on any of the other measures. We concluded that the positive atmosphere that humor creates affects the therapeutic alliance between staff and patients but does not affect other social networks because of the regressed nature of the schizophrenics' social relationships.

The threat of a chemical war has profound impacts on all layers of society. Hospitalized mental patients, as we have observed them, react in more extreme ways than staff members. They may react overanxiously, totally apathetically, or in context-related flights to partial sanity. Denial and projection were heavily used defense mechanisms together with a tendency of the more acute patients to plunge into their bizarre idiosyncratic world, lending strange meanings to what was happening in the world. Many patients were found to have strong narcissistic traits and to invest most of their libidinal energies in their private world. In times of stress this results in even greater social isolation. Different types of patients in different phases of their illness react differently to such overpowering stress, and the way they react illustrates their cognitive, behavioral, and social deficiencies. WWII literature on the reactions of mentally ill patients to "fly-bombing" seem not to take into consideration the different possible reactions of patients. This may be due to a change in emphasis in the care of mentally disturbed individuals in the last two decades. We propose to use even such an extremely stressful situation as a challenge to the mental health profession to further the well-being of their patients.

The study was designed to explore the potential therapeutic effects of humor on hospitalized schizophrenics. For this purpose, in the first stage, we conducted a review of findings in regard to physical health, emotions, psychiatric state, and social behavior. In the second stage, we carried out an experiment with 34 resident patients in two chronic schizophrenic wards who were exposed to 70 movies during 3 months. The experimental group was exposed to humorous movies only, and the control group to different kinds of movies. Before and after the exposure to films for 3 months, both groups were tested on different health, emotional, social, and clinical measures using the Cognitive Orientation of Health Questionnaire, the Shalvata Symptom Rating Scale, blood pressure, heart rate, Perceived Verbal and Motor Aggression (rated by nurses), the Multiple Affect Adjective Check List, the Social Support Questionnaire 6, and the Brief Psychiatric Rating Scale (BPRS; rated by psychiatrists). Covariance analyses yielded significant reductions in Perceived Verbal Hostility, BPRS scales (total score, anxiety/depression), and significant increases in BPRS (activation) and degree of staff support experienced by the patients. The results indicate that the effects of exposure to humor may be mediated by the effects on the staff of the incidental exposure to humorous films.

Using the diagnostic criteria found in the literature, 15 new cases of Ganser syndrome were examined. A relationship was found between specific premorbid personality traits and severity of the syndrome; a high percentage of the sample belonged to an ethnic minority and was suspected of having symptoms of premorbid neurological pathology.

A multicenter prospective open study was performed in order to compare the effectiveness of 2 modalities of individual dynamic psychotherapy in a group of recently detoxified opioid dependent patients. Thirty four patients were assigned to receive either short-term dynamic psychotherapy (ST) or long-term dynamic psychotherapy (LT); both modalities were offered along with drug counselling. At the end of the treatment, the short term therapy group was followed up for 2 years, while the long term therapy group continued the follow up for one year, due to the different time span of the treatment approaches. Dropout rates for ST (47%) and LT (53%) patients were similar, and the re-entry rate for the ST group was superior (62.5% vs. 28.5%). Short term interventions appear to be at least as effective as long term interventions, and have the advantage of a high rate of program re-entry. Further studies conducted on larger samples are needed.

In a double blind study, out of 31 newly abstinent patients who underwent opioid free detoxification, 15 were started on the opiate antagonist Naltrexone for 2 months, and 16 were put on placebo for the same period. Given Naltrexone's known efficacy in blocking euphorigenic effects of opioid intake, and in decreasing cravings for the drug, the authors have tried to assess eventual drug taking, specifically in the context of suburban housing projects, and evaluate the rate of retention in a rehabilitative program for both the Naltrexone and placebo groups. An Opioid free condition was followed up for a year, also respecting double blind conditions. Naltrexone did not appear to be superior to the placebo with regards to retention rate. In the Naltrexone group (n = 15), 9 finished the two-month treatment, and 8 remained opioid-free for a year. In the placebo group (n = 16), 8 finished the 2 month trial and 6 remained opioid-free for a year. Naltrexone blocked opioid-induced euphoria and decreased the craving for opium, but it did not inhibit drug usage. The retention rate registered during the course of the study, as well as an opioid-free condition in the follow-up year, correlated with a patient profile defined by good social functioning and stable relationships. The inherent methodological limitations of this study did not allow for the discrimination of the role of non-pharmacological factors, such as psychotherapy, supportive family framework, community assistance, and staff motivation, concerning the clinical results. Further investigation of Naltrexone in larger samples is needed.

The clinical picture of Munchausen syndrome is that of feigned or self-induced illness with the aim of being hospitalized and/or receiving unnecessary medical interventions, peregrination from 1 hospital to another, and disruptive behavior when hospitalized. These patients are a danger to themselves and heavily burden inpatient facilities that care for them. We present a case that illustrates the problems of diagnosing and managing such patients. We stress the need for adequate centralization and distribution of the relevant information concerning these patients.

A new variant of Munchausen Syndrome by Proxy (MSbP) case is presented here: Munchausen by Adult Proxy (MSbAP). The article discusses the case of a man (publicly known as the "Gasoline Injector") who is serving a 46-year jail term for attempted murder and manslaughter. His behavior is reminiscent of MSbP but his victims were two female adults, and his cell mate (on whom he repeated his actions). A description is given in terms of egosyntonic irresistible pathological impulses involving sexual objects. A common ground is proposed for paraphilias, Munchausen syndrome, MSbP and MSbAP.

In 1977 a new paragraph was added to Israel's penal law allowing rehabilitation of convicted drug abusers by compulsory psychiatric treatment. The commitment was implemented on the basis of a court order. Notwithstanding the doubts of psychiatrists the law permitted the commitment of a significant number of drug abusers to psychiatric wards. The rehabilitation treatment through commitment and some of its negative consequences are described in a study that covers 10 years of activity at the Pardessia Menta Health Center. We present 3 typical profiles of drug abusers who were treated in our center as specified by the law. None needed medical help in physical withdrawal from the drug. All took advantage of the opportunity to spend part of their incarceration time in the hospital instead of in jail. The law was amended in July 1989 and since February 1990 treatment is conducted under the supervision of probation officers and not in a medical institution. The amended law reflects the approach to drug abuse as a social not psychopathological problem, so that social agencies and no medical instances are in charge.

The patient with combat-related chronic Posttraumatic Stress Disorder suffers from a wide spectrum of maladaptive behaviors. This paper delineates the work that has been done with such a population in group therapy. The plan that is proposed takes into account three interrelated sets of factors: factors important for creating an effective working relation; curative factors; and particular themes. Each of these factors is analyzed in the light of the particularities of group work with such a population. Each of the points discussed is based upon the relevant literature, upon the experience of the therapist, and illustrated with examples.

The Munchausen by Proxy syndrome is described, and illuminated by case histories. A plea is put forward for the adoption into Israeli law of the doctrine of diminished responsibility, as perpetrators of crimes who suffer from the MbP syndrome are treated by the law as if they had no psychiatric disability.

This paper compares patient functioning during a maintenance workers' strike. Four criteria were used to assess change: 1) patients' functioning as evaluated by five independent judges on a questionnaire; 2) number of days out of the hospital; 3) number of days of closed intensive therapeutic ward hospitalization and 4) number of patients that underwent a major improvement during that period. A positive therapeutical effect in patients as a result of the strike has been found. This effect is thought to be due to the staff's higher expectations towards the patients, and not due to a need of the patients to restore a sense of balance in the threatened family-like system of the ward--as was believed in a previous study (1). The role of the staff in helping the patient to constructively cope with the strike is discussed.

The Munchausen By Proxy Syndrome (MbPS) is a complicated phenomenon whereby a peculiar threefold relationship between perpetrator, victim, and medical staff develops. This triad is based on abuse of the child, deception of the doctor, and, in many cases, self-abuse or passivity of the victim towards the perpetrator's deeds. We have analyzed the interrelationship between the perpetrator, the victim, and the medical authority, in light of the mother's pathology.