Search

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.

Background Restraint or seclusion measures in acute psychiatric care are used as a last resort when all other methods for removal of physical threat have failed. The purpose of this study is to find a correlation between coercive measures, demographic characteristics within this patient group, and factors associated with shortened periods of restriction. Methods This is a one-year retrospective study conducted in a male acute closed ward of a psychiatric hospital in Israel. The data from January 1, 2014 to December 31, 2014 were retrieved from the records of patients who underwent restraint and/or seclusion interventions during this period. The analyzed data included age, psychiatric diagnosis, marital status, education, race, ethnicity, length of hospital stay, legal status during admission, type of coercive measure (mechanical restraint, seclusion), number and duration of coercive episodes, reasons for coercion, time of event, number of previous hospitalizations, aggression in past and present treatment, and treatment during events. Results During this time period, there were 563 admissions in the study ward. Over this period, 176 subjects (31.3%) underwent 488 restraints and/or seclusions. 98% were aggressive in the past. (Although some results reached statistical significance, we prefer to emphasize here only the most important results, while the others will be presented in the text.) Patients with personality disorders were physically limited for the longest time, while schizophrenia patients were restricted for the shortest time compared with other diagnoses (p = 0.007). A negative correlation was found between the length of coercion and the number of academic female nurses on duty (p = 0.005), as well as the administration of sedative medications during the restricting procedure. Conclusions We believe that the presence of registered, academic female nurses on duty and medication administration during coercive measures can reduce the length of restriction.

The Israel Mental Health Act of 1991 stipulates a process for involuntary psychiatric hospitalization (IPH). A patient thus hospitalized can 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. This study attempts to compare the variance between the TP and the DPC decisions in different geographical regions in Israel.We examined the outcomes of 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 taken from the Israel National Register. We also collected information regarding all IPH discharges owing to the TP's decision for 2013 (N = 5788). We defined "failure" as readmission in fewer than 30 days, involuntary civil readmission in fewer than 180 days, and involuntary readmission under court order in less than 1 year.The re-hospitalization pattern was compared in the two groups of patients discharged from psychiatric hospitalization during 2013 (index discharges) and followed up individually for a year. We found a statistically significant difference between the success rates of the various regional DPCs and the hospital TP groups, with the TP average (74.5% national success rate) success significantly better than the DPC groups (66.7% national success rate). Moreover, the variance between the decisions made in the different geographical regions in the two groups was also statistically significant (σ2 variance was 80.4 and 27.1 for the DPC and TP groups, respectively).The results we present indicate that the variance of decision "failure" (readmission) and "success" across the various geographical regions was found to be significantly better in the TP group than in the DPC group. We consider it likely that whereas TPs discharge IPH patients in accordance with well-accepted clinical approaches, the DPC's decisions are based on interpretations of the law (regarding, e.g., the patient posing a physical threat) and on the DPC's understanding of what is meant by the patient's "best interests." We suggest introducing more formal psychiatric training for the legal staff of the DPCs and building a structured and standardized method for reviewing the patient. Moreover, we propose using "soft paternalism" as an approach, which would justify limitations on individual liberties for the benefit of persons being restricted, provided that they are unable to make a choice that would be consistent with their own interests. This is often an appropriate and perhaps a more practical approach, one that the DPC could adopt in place of the present conservative approach, which requires a specific standard of "proof" of major illness to qualify as insanity requiring hospitalization.

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.

We describe a patient at acute suicide risk. His Rorschach protocol was analyzed using Exner's Comprehensive System and a number of psychoanalytic scales. The results pointed at a predominance of borderline defenses, identification with abusers and victims, symbiotic and violent interpersonal relations, self-fragmentation, and intertwined dynamics of suicide and pedophilia. Traumata internalization led to negative body experience, re-staging of the struggle with abusers in relation to his body, feelings of being infested by the trauma, and ruthless self-attacks. His suicide dynamics consist of blurred self-other boundaries, ecdytic fantasies, trauma internalization, and an attempt to exterminate a bad object through self-destruction.

Overnight melatonin levels were measured in five male schizophrenic patients on steady antipsychotic treatment following the addition of fluvoxamine. Melatonin secretion increased in the first week of treatment and progressively decreased after 3 weeks. The findings are consistent with the development of tolerance in the processes underlying melatonin secretion. © 1997 John Wiley & Sons, Ltd.

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

The effect of add-on fluvoxamine on platelet MAO activity was studied in nine chronic schizophrenic patients on steady antipsychotic treatment. Platelet MAO activity decreased significantly after 5 weeks of treatment and remained depressed. Since fluvoxamine does not inhibit MAO activity in vitro, the findings, which are preliminary, raise the possibility that chronic SSRI treatment may modify MAO production.