Showing papers in "Israel Journal of Psychiatry and Related Sciences in 2016"

An Empirical Study of the Relationship Between Community Participation, Recovery, and Quality of Life of Individuals with Serious Mental Illnesses

Abstract: Background Recovery and quality of life are key outcomes emphasized in mental health systems around the world. This study explores the extent to which efforts to facilitate community participation may enhance these outcomes. Methods Six hundred and six individuals with serious mental illnesses completed measures of participation, recovery and quality of life. Results Small, but statistically significant positive relationships between community participation and recovery and quality of life were found. Additional analyses identified specific participation areas that, if they are important and done sufficiently from the perspective of the respondent, resulted in higher levels of recovery and quality of life. Limitations Correlational analyses do not allow for causal explanations. Conclusions Results suggest that a greater emphasis on community participation, especially in specific areas that are important to the person and done sufficiently, may facilitate recovery and quality of life in community mental health systems. Implications and possible directions for policies and practices, especially within the context of Psychiatric Rehabilitation services, are offered.

Prevalence of ADHD among 7-9-Year-Old Children in Israel. A Comparison between Jewish and Arab Populations.

Abstract: Introduction The world prevalence of ADHD ranges between 5-10%. The prevalence in Israel was generally studied from prescriptions of methylphenidate and not from cohorts of children. Methods We assessed the prevalence of ADHD among a cohort of early school age children in the Jewish and Arab populations using DSM-IV criteria and evaluated the difference between teachers' and parental assessment. We also studied in the Jewish population the differences in several social-behavioral parameters between children with and without ADHD. Results The rate of ADHD among the Jewish children was 9.5% and among the Arab children it was significantly lower - 7.35%. Teachers' evaluation in the Jewish population was 2.3 times higher than parental evaluation but in the Arab population it was closer to that of the parents, being only 12% higher. In addition, there were more regulatory, behavioral and learning problems among the Jewish children with ADHD compared to children without ADHD. Conclusions The rates of ADHD in school age children among both Jews and Arabs fall within the average rate in other countries. The high difference between teachers' and parental assessment of ADHD in the Jewish population emphasizes that ADHD diagnosis should rely on the joint behavioral assessment of both. The prevalence of ADHD in Jewish early school age children is slightly higher than in Arab children and the inattentive type is the most common. There is a discrepancy between teachers' and parents' evaluation of children's behavior in the Jewish population, but this discrepancy is less in the Arab population.

Improving Community Mental Health Services: The Need for a Paradigm Shif.

Abstract: Background: It is now over half a century since community care was introduced in the wake of the closure of the old asylum system. This paper considers whether mental health services,regardless of location,can be genuinely effective and humane without a fundamental paradigm shift. Data: A summary of research on the validity and effectiveness of current mental health treatment approaches is presented. Limitations: The scope of the topic was too broad to facilitate a systematic review or meta-analyses,although reviews with more narrow foci are cited. Conclusions: The move to community care failed to facilitate a more psychosocial,recovery-focused approach,instead exporting the medical model and its technologies,often accompanied by coercion,into a far broader domain than the hospital. There are,however,some encouraging signs that the long overdue paradigm shift may be getting closer.

Comorbidity of Post-traumatic Stress Symptoms and Depressive Symptoms among Obstetric Nurses with Perinatal Death Exposure.

Abstract: Background Mental health and well-being among obstetric nurses after perinatal death is understudied. The primary goal of this study is to explore the comorbidity of post-traumatic stress disorder (PTSD) symptoms and depressive symptoms among obstetric nurses. In addition, we explore associations between personal resources - coping self-efficacy and active social support - and comorbidity symptoms. Method One hundred and twenty-five obstetric nurses who represent 25% of the entire population of Israeli obstetric nurses completed self-report questionnaires regarding demographic data, coping self-efficacy, active social support, history of exposure to traumatic events, PTSD symptoms and depressive symptoms. Results An elevated risk of PTSD among obstetric nurses was positively associated with an elevated risk of depression and age while negatively associated with coping self-efficacy. Conclusions These findings may suggest that nurse educators, administrators and leaders in the midwifery practice should promote stress intervention, supportive clinical environments and educational programs among obstetric nurses.

Burnout of Formal Caregivers of Children with Cerebral Palsy.

Abstract: BACKGROUND Burnout syndrome is under-researched within caregivers (CGs) of children with cerebral palsy. The primary aim was to determine the burnout level of formal CGs of children with cerebral palsy (G1) and to compare it with a control group (G2) of professional pediatric nurses, and second, to correlate the level of depression and anxiety with the burnout level. METHOD In a total sample of 60 CGs, the Maslach Burnout Inventory Human Services Survey (MBI-HSS), consisting of three structural units - emotional exhaustion (MBIEE) subscale, depersonalization (MBI-DP) subscale and personal accomplishment (MBI-PA) subscale - was used to measure burnout. The Beck Anxiety Inventory (BAI) was used for the assessment of anxiety, and the Beck Depression Inventory (BDI) for depression. RESULTS A significant difference was shown on the MBI-EE subscale and on the BDI test (p<0.05), in both cases higher scores were obtained by G1. High burnout was observed in all subscales, on the MBI-EE subscale registered 50% of CGs in G1, and 17% in control G2. Correlation of the MBI-EE subscale with BDI and BAI tests was highly significant (p<0.01). CONCLUSIONS These findings indicate the need for future research aimed at formulating preventive strategies for caregivers' mental health. Better care for caregivers would provide them with better professional satisfaction, and consequently would lead to better care for patients.

Enhancing Children's Resilience in Schools to Confront Trauma: The Impact on Teachers.

Abstract: BACKGROUND Children's exposure to stressful events requires effective interventions to strengthen adaptive development. Expanding the teachers' role to deliver resilience-focused interventions has been shown to enhance children's coping and to have a positive impact on the teachers themselves. METHOD This study compared the self-efficacy and perceived performance of 48 teachers following the implementation of such an intervention with 52 control teachers. RESULTS Trained teachers reported higher self-efficacy and perceived performance. Associations between years of experience, perceived performance and self-efficacy are discussed. CONCLUSIONS This study provides further evidence on the positive impact of teacher-delivered interventions on teachers' performance and self-efficacy. Future studies should replicate this design with a larger sample to examine stages of professional experience, grades, before-after measures, association with students' coping and include male teachers.

The Role of Maternal Distress in the Report of Behavioral and Emotional Problems among Children with Chronic Disabilities.

Abstract: BACKGROUND Assessments of psychological symptoms in children often rely on caregivers' (usually mothers') reports. However, the reliability may be affected by the caregivers' own emotional distress (ED). The main objectives of this study were to assess the variability in ED of mothers of children with chronic physical disabilities, and its association with the ratings of their children's emotional and behavioral problems. METHODS Medical data of children diagnosed with chronic disabilities were analyzed (N = 72). Mothers completed the 12-item General Health Questionnaire (12-GHQ) to measure ED and the Child Behavior Checklist (CBCL) to assess children's emotional and behavioral problems Mothers' ED scores were compared with communitybased counterparts with similar socio-demographic characteristics (N = 657) from the Israel National Health Survey (INHS). RESULTS Mothers of children with chronic physical disabilities had higher levels of ED compared to mothers in the general population. About 20% of the sample mothers had 12-GHQ scores compatible with DSM- IV depression or anxiety disorders. No differences in ED were found according to the type of child's disability or IQ score. Marked differences in CBCL scores were reported by mothers with high versus low ED, controlling for baseline maternal and child characteristics. CONCLUSIONS High levels of maternal ED were associated with mothers' reports on child's behavioral and emotional problems.This may contaminate the reliability of parental reports on their child's psychological state.

Parent-child Interaction Treatment for Preschoolers with Feeding Disorders.

Abstract: Background This study examined the immediate outcome of Feeding Disorders (FD) in preschoolers referred to the family treatment program Cerco Asilo. Method 21 children (mean age [SD=1]: 39 months [1]; range 9-65 months) with a diagnosis of FD were included in the treatment for 24 weeks. Specifically, seven subjects were diagnosed with Infantile Anorexia (IA), nine subjects with Sensory Food Aversion (SFA), and five subjects with Feeding Disorder of Caregiver-Infant Reciprocity (FDCIR). Results The great majority of patients with SFA and with FDCIR resolved the FD, whereas children with IA did not respond well to the treatment. Limitations The study's main limitations are the relatively small sample size, and the lack of a control group. Conclusions Findings suggest that changes in the parentchild relationship could generally promote FD resolution, other than IA. These data may have implications for clinical practice suggesting the need to develop ad hoc intervention protocols tailored to children with IA and their families.

Cannabis and Alcohol Abuse Among First Psychotic Episode Inpatients

Abstract: Background Psychoactive substance abuse, which includes abuse of alcohol and street drugs, is common among first-episode psychosis patients, but the prevalence of cannabis abuse is particularly high. However, there have been very few reported studies concerning the occurrence of psychoactive substance abuse among first-episode psychotic individuals using standard toxicological testing. We study the prevalence of cannabis and alcohol abuse among first-psychoticepisode inpatients as well as compare the demographic, diagnostic, and psychopathological profiles of substance abusers versus nonusers. Methods Subjects were recruited from the Jerusalem Mental Health Center between 2012 and 2014. Ninety-one consecutively admitted psychiatric patients diagnosed using the DSM-IV criteria with a first psychotic episode due to schizophrenia, schizophreniform disorder, bipolar disorder, brief psychotic episode, and psychosis NOS disorder entered the study. The diagnoses of schizophrenia (all types), psychosis NOS disorder, brief psychotic episode, and schizophreniform disorder were categorized as "only psychosis" and those of bipolar disorder manic episode with psychotic features (congruent and incongruent) and severe depression with psychotic features were categorized as "predominantly affective symptoms." Urine tests for tetrahydrocannabinol (THC) were performed during the first 48 hours of admission, and likewise self-report questionnaires were administered. Alcohol abuse and dependence were diagnosed by self-report. Results Of the 91 subjects in the study, 49 (53.8%) did not abuse any illegal psychoactive substance. Twenty patients (22%) abused only cannabis; 14 (15.4%) abused cannabis and another psychoactive substance; 54 (59.3%) of the subjects reported no alcohol abuse; 33 (36.3%) reported occasional drinking (between two and ten times a month); and 4 (4.4%) reported continuous repeated drinking (more than ten times a month). There was no correlation between the demographic characteristics and the abuse of cannabis. Two-thirds of the "predominantly affective symptoms" subjects were positive for THC, whereas only a third of the "only psychosis" subjects screened positive for THC. Conclusions The percentage of cannabis and alcohol abuse in the study population is much higher than one would expect to see in the general Israeli population (according to the Knesset Research Department 7.6-10.2% of the adult Israeli population abuse cannabis). Different patterns of cannabis abuse among "predominantly affective" and "psychotic only" patients may lend credence to the preferential use of a specific substance per diagnosis.

Training Arab Practitioners in Culturally Sensitive Mental Health Community Interventions.

Abstract: BACKGROUND This study examined the immediate outcome of Feeding Disorders (FD) in preschoolers referred to the family treatment program Cerco Asilo. METHOD 21 children (mean age [SD=1]: 39 months [1]; range 9-65 months) with a diagnosis of FD were included in the treatment for 24 weeks. Specifically, seven subjects were diagnosed with Infantile Anorexia (IA), nine subjects with Sensory Food Aversion (SFA), and five subjects with Feeding Disorder of Caregiver-Infant Reciprocity (FDCIR). RESULTS The great majority of patients with SFA and with FDCIR resolved the FD, whereas children with IA did not respond well to the treatment. LIMITATIONS The study's main limitations are the relatively small sample size, and the lack of a control group. CONCLUSIONS Findings suggest that changes in the parentchild relationship could generally promote FD resolution, other than IA. These data may have implications for clinical practice suggesting the need to develop ad hoc intervention protocols tailored to children with IA and their families.

Cultural Impact on SAD: Social Anxiety Disorder among Ethiopian and Former Soviet Union Immigrants to Israel, in Comparison to Native-born Israelis.

Abstract: Background Social Anxiety Disorder (SAD) is linked to social norms and role expectations which are culture dependent, such as the construal of one's self as independent or interdependent in relation to others. The current study is the first to examine SAD symptoms among Ethiopian and former Soviet Union immigrants to Israel compared to a sample of native Israelis. We investigated the relationship between SAD, ethnicity and independent/ interdependent self-construals. Methods A total of 261 students (151 native-born Israelis, 60 Ethiopian immigrants and 50 students from the former USSR) were administrated the Liebowitz Scale (LSAS), the Self-construal Scale (SCS), Beck Depression Inventory (BDI) and a socio-demographic questionnaire. Results Ethiopians exhibited highest SAD scores while no differences were found between the FSU immigrants and native-born Israelis. Additionally, Ethiopians and native-born Israeli students exhibited similar high interdependence scores. Finally, SAD scores were predicted by gender, origin, independent and interdependent self-construals. Conclusion Immigration per se is not a universal risk factor of SAD and ethnological-cultural factors do contribute specifically to SAD. A possible psychological mediator between culture and the susceptibility to SAD are the interdependence and independent self-construals. When treating immigrants, clinicians and health care providers are advised to consider the effect of cultural influence on the mental well-being and integration process of immigrants in to their host country.

Parent-child Communication-centered Rehabilitative Approach for Pediatric Functional Somatic Symptoms.

Abstract: Background Functional somatic symptoms (FSS) are a type of somatization phenomenon. Integrative rehabilitation approaches are the preferred treatment for pediatric FSS. Parental roles in the treatment process have not been established. Study aims to present 1) a parent-focused treatment (PFT) for pediatric FSS and 2) the approach's preliminary results. Methods The sample included 50 children with physical disabilities due to FSS. All children received PFT including physical and psychological therapy. A detailed description of the program's course and guiding principles is provided. Outcome measures FSS extinction and age-appropriate functioning. Results Post-program, 84% of participants did not exhibit FSS and 94% returned to age-appropriate functioning. At one-year follow-up, only 5% of participants experienced symptom recurrence. No associations were found between pre-admission symptoms and intervention duration. Conclusion PFT is beneficial in treating pediatric FSS. Therefore, intensive parental involvement in rehabilitation may be cardinal.

Religious-Ethnic Differences in Prevalence and Correlates of Suicidal Ideation and Attempts Among Israeli Vocational Education Students.

Abstract: BACKGROUND The current study is the first to examine serious suicidal ideation, suicide attempts and psychological distress among students belonging to different religious-ethnic groups attending VET high schools. METHOD 3,553 students studying in the VET high schools completed a self-report survey. The survey evaluated serious suicidal ideation, suicide attempts, depression, anxiety, somatization, self-efficacy, belonging and sociodemographic variables. RESULTS Students coming from minority groups (Arab Muslim, Bedouin Arab Muslim, Druze) are more likely to have seriously considered suicide or attempted suicide compared to their Jewish counterparts, with the exception of Christian Arabs. Bedouin Arab Muslim students were more susceptible to suicide ideation and attempts upon high depression levels. CONCLUSIONS Minority youth at VET schools are at greater risk of experiencing suicidal ideation and attempting suicide compared to non-minority students. The education system must be highly alert to depressive symptoms among Bedouin Arab Muslim students since they may pose a greater risk to develop into suicidal ideation and attempt.

Community Mental Health Policy in America: Lessons Learned.

Abstract: After 1945 the prevailing consensus that persons with serious mental disorders should be treated in public hospitals began to dissolve. It was replaced by a faith in the efficacy of community care and treatment. Yet for a variety of reasons the new community care system fell far short of its initial promise. Advocates failed to understand that the problems of persons with serious and persistent disabilities were different from those people with mild and moderate disorders. The belief that residence in the community would promote adjustment and integration was illusory and did not take into account the extent of social isolation, exposure to victimization, inducement to substance abuse, homelessness, and criminalization of persons with mental disorders. Effective community care for those previously kept in hospitals must make up for the range of functions that hospitalization was intended to provide, from housing and supervision to treatment and rehabilitation.

The Association between Obesity and Symptoms of Psychopathology and its Relationship with Sedentary Behavior and Mediterranean Diet.

Abstract: BACKGROUND Recent research indicates an association between obesity and symptoms of psychopathology, the nature of which remains obscure. This study examined the confounding role of behavioral factors on this association. METHOD One hundred and forty-two overweight/obese subjects who sought treatment for obesity, of both genders (51 males and 91 females), 18 to 64 years old and 139 normal-weight controls of both genders (41 males and 98 females), 18 to 63 years old, were enrolled in this study. We measured psychopathology features, using the Symptom Checklist 90-Revised (SCL-90-R), dietary habits, using the MedDietScore (MDS) questionnaire, and physical activity, using the International Physical Activity Questionnaire (IPAQ). A series of regression models were used to estimate the mediation of dietary patterns and physical activity on the obesity-psychopathology association. RESULTS The associations between obesity and depression (β=0.32/β=0.15), obsession-compulsion (β=0.03/β=-0.13), anxiety (β=-0.25/β=-0.12), interpersonal sensitivity (β=0.08/β=-0.04) and psychoticism (β=-0.01/ β=0.025) are accounted for by sedentary behavior and Mediterranean diet. CONCLUSIONS Our data suggest that modifiable behavioral factors such as sedentary time and dietary patterns positively affect the association between obesity and symptoms of psychopathology.

Simulation of Mental Disorders: I. Concepts, Challenges and Animal Models.

Abstract: The complexity of the human brain and the difficulties in identifying and dissecting the biological, social and contextual underpinnings of mental functions confound the study of the etiology and pathophysiology of mental disorders. Large-scale computer simulation of the human brain was recently proposed as a method to circumvent some of these difficulties. In this two-partpaper, we discuss selected conceptual and pragmatic issues pertaining to the mental illness simulation in general and computer simulation in particular. We address the merits and limitations of two generic types of simulation vehicles, biological simulation in animal models (Part I) and virtual simulation in computer models (Part II), in the study of mental disorders in humans. We point to the need to tailor the vehicle and method of simulation to the goal of the simulation, and suggest future directions for maximizing the utility of mental illness simulation. We argue that at the current state of knowledge, the biological-phenomenological gap in understanding mental disorders markedly limits the ability to generate high-fidelity biological and computational models of mental illness. Simulation focusing on limited realistic objectives, such as mimicking selected distinct biological and phenomenological attributes of specific mental symptoms, may however serve as a useful tool in exploring mental disorders.

Simulation of Mental Disorders: II. Computer Models, Purposes and Future Directions.

Abstract: The complexity of the human brain and the difficulties in identifying and dissecting the biological, social and contextual underpinnings of mental functions confound the study of the etiology and pathophysiology of mental disorders. Simulating mental disorders in animal models or in computer programs may contribute to the understanding of such disorders. In the companion paper (30), we discussed selected concepts and pragmatics pertaining to mental illness simulation in general, and then focused on issues pertaining to animal models of mental disease. In this paper, we focus on selected aspects of the merits and limitations of the use of large scale computer simulation in investigating mental disorders. We argue that at the current state of knowledge, the biological-phenomenological gap in understanding mental disorders markedly limits the ability to generate high-fidelity computational models of mental illness. We conclude that similarly to the animal model approach, brain simulation focusing on limited realistic objectives, such as mimicking the emergence of selected distinct attributes of specific mental symptoms in a virtual brain or parts thereof, may serve as a useful tool in exploring mental disorders.

Psychological Factors Associated with Emotional Distress among Palestinian Arabs from East Jerusalem Accessing Psychiatric Care in Israel.

Abstract: Background The Palestinian population residing in East Jerusalem is characterized by high rates of poverty and unemployment and is subject to discrimination in various forms, including infrastructure of mental health services. Little is known about the help seeking needs and practices of East Jerusalem residents. Method We examined socio-demographic and clinical characteristics of a consecutive sample Palestinian residents from East Jerusalem (N=50) who accessed a specially assigned psychiatric clinic in Israel. In addition, we examined the psychological factors associated with emotional distress among these service-users upon entry to care. Participants completed a survey in Arabic that included a socio-demographic questionnaire and measures assessing emotional distress, perceived exposure to discrimination and social support, and mental health stigma. Results Participants reported high levels of emotional distress. Female gender, low socioeconomic status, higher perceived exposure to discrimination and higher perceived social support were associated with increased emotional distress. Conclusions Findings add to the scarce body of knowledge on specific mental health characteristics of East Jerusalem Palestinian residents.

Individual Psychotherapy ("Talking Therapy"): A Survey of Attitudes among Residents & Specialists in Psychiatry, Israel 2010-2011.

Abstract: Background Individual psychotherapy is an efficient tool and an integral part of psychiatric treatment. However, its status among psychiatrists in Israel has never been explored. Objectives To explore and map the attitudes of psychiatrists in Israel regarding psychotherapy and psychotherapy training during residency, with comparisons between residents vs. specialists, peripheral vs. central institutions and mental health vs. medical centers. Method We conducted a cross-sectional survey to examine the attitudes toward individual psychotherapy. The questionnaire was delivered via email and direct approach to psychiatrists in Israel. Results The survey was completed by 229 of 1,502 registered psychiatrists (15.3%). While 96% (n=218) had positive attitudes towards psychotherapy, 93.1% (n=215) thought psychotherapy was less available than pharmacotherapy. Psychiatrists from peripheral institutions prefer cognitive behavioral therapy, while psychiatrists from central institutions prefer dynamic psychotherapy. Psychiatrists from mental health centers use more dynamic psychotherapy compared to psychiatrists from medical centers. The number of dynamic psychotherapy treatments psychiatrists delivered during their residencies has been decreasing over time, meaning residents today deliver fewer dynamic psychotherapy treatments compared to the number of treatments specialists delivered during their residencies. Additionally, 97.4% (n=225) believed psychotherapy training should be included in the psychiatric residency and 87.3% thought that the training should be improved to a great extent. Conclusions The survey demonstrates mixed but overall positive attitudes towards psychotherapy among psychiatrists in Israel. The findings should be taken into consideration by psychiatrists who design the residency program and by policy makers who are in charge of the mental health reform in Israel, or the psychotherapy usage and therapeutic potential may diminish, as has happened in other countries.

Combat Experience and Mental Health in the Israel National Health Survey.

Abstract: OBJECTIVE 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. RESULTS 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. CONCLUSION 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.

Community Mental Health as a Population-based Mental Health Approach.

Abstract: Background: Mental health services for youths in Singapore were challenged by accessibility and resource constraints. A community-based mental health program working with schools and other partners was developed to address the population needs. Aim: To describe the formation of a community-based mental health program and evaluate the program in terms of its outcome and the satisfaction of the users of this program. Methods: Based on needs analyses, a community multidisciplinary team was set up in 15 schools to pilot a new model of care for youths. Implemented progressively over five years,networks of teams were divided into four geographic zones. Each zone had clusters of 10 to 15 schools. These teams worked closely with school counselors. Teams were supported by a psychiatrist and a resident. Interventions were focused on empowering school-based personnel to work with students and families,with the support of the teams. Results: 4,184 students were served of whom 10% were seen by the school counselors and supported by the community team. Only 0.15% required referral to tertiary services. Outcome measured by counselor and teacher ratings showed improvements in the Clinical Global Impression scale and Strengths and Difficulties Questionnaire. These included reductions in conduct problems,emotional problems,hyperactive behaviors and peer problems. Furthermore,prosocial behavior also significantly improved. Preliminary cost effectiveness analyses suggest that community treatments are superior to clinic interventions. Conclusion: There is evidence that a population-based community mental health program with schools can be implemented through a multisectoral approach with good outcomes that is cost effective.

Parents' and Teachers' Perceptions of Abnormal Attention Span of Elementary School-Age Children.

Abstract: Background To determine teacher and parental perception of minimal expected sustained attention span during various daily tasks among elementary school children. Methods 54 parents and 47 teachers completed the attention span questionnaire (AtSQ) that was developed for this study. The AtSQ consists of 15 academic and leisure tasks that require a child's sustained attention. The study focused on third and fourth graders in Israel. Results There was a high degree of variability among teachers and parents in their responses to the AtSQ. The expected attention span of children as judged by parents was higher and more varied compared to teachers, and higher for girls than for boys. Conclusions Our results indicate poor agreement in cutoff values for sustained attention span between teachers and parents and within each group.

Psychiatric Consultation in Community Clinics: A Decade of Experience in the Community Clinics in Jerusalem.

Abstract: INTRODUCTION A consultation model between primary care physicians and psychiatrists that has been in operation for 12 years in the Jerusalem district of the Clalit Health Services in Israel is evaluated. In this model psychiatrists provide consultations twice a month at the primary care clinic. All patients are referred by their family physicians. Communication between the psychiatric consultant and the referring physician is carried out by telephone, correspondence and staff meetings. OBJECTIVE Evaluation of the psychiatric care consultation model in which a psychiatrist consults at the primary care clinic. METHOD A questionnaire-based survey distributed to 17 primary care physicians in primary care clinics in Jerusalem in which a psychiatric consultant is present. RESULTS Almost all of the doctors (93%) responded that the consultation model was superior to the existing model of referral to a secondary psychiatric clinic alone and reduced the workload in caring for the referred patients. The quality of psychiatric care was correlated with the depression prevalence among patients referred for consultation at their clinic (r=0.530, p=0.035). In addition, correlation was demonstrated between primary care physicians impression of alleviation of care of patients and their impression of extent of the patients' cooperation with the consulting psychiatrist (r=0.679, p = 0.015) Conclusions: Very limited conclusions may be drawn from this questionnaire distributed to primary care physicians who were asked to assess psychiatric consultation in their clinic. Our conclusion could be influenced by the design and the actual distribution of the questionnaires by the consulting psychiatrist. Nevertheless answers to the questionnaire might imply that the consultation model of care between a psychiatric consultant and the primary care physician, where the patient's primary care physician takes a leading role in his psychiatric care, is perceived by family physicians as a good alternative to referral to a psychiatric clinic, especially when treating patients suffering from depression.

Short-term Focused Inpatient Treatment Combined with Sensory Regulation of Sexual Trauma Victims - Summary of 100 First Hospitalizations.

Abstract: Background Treatment of sexual trauma victims may be fraught with crises. In situations of de-compensation, the frequency of suicide attempts is high, and ambulatory treatment may not always provide the required response. In extreme cases, either in close proximity to the sexual offence or even years later, a more intense intervention is needed. This includes removing sexual trauma victims from their daily lives and hospitalization. Caregivers debate the type of hospitalization needed and the best type of treatment in times of decompensation and dissociation. Method This paper depicts a hospitalization model in Israel that has been created to provide a unique and focused solution for sexual trauma victims. The psychological principle of the hospitalization is based on Mann's shortterm dynamic psychotherapy method. The patients are integrated in an acute psychiatric ward in which a variety of psychopathologies, men and women, are treated. Results The paper summarizes findings and understandings from the first 100 hospitalizations. The author's main conclusion is that sexual trauma victims need a focused specialized treatment plan to best deal with their complex issues and that hospitalization should be minimized to two weeks. Conclusions The author's main recommendation is that funding must be allocated for hospital beds for sexual trauma victims in each region in the country to produce adequate continuity of care for these patients.

The Transition from Psychiatric Hospitalization to Community Living: Local and Current Challenges.

Abstract: While extensive efforts have been made in recent decades to enhance community mental health services around the world and in Israel, less attention has been given to the challenging transitional period from psychiatric hospitalization to community living. The current paper reviews the literature on discharge planning programs, which shows that using an interdisciplinary team and adapting a case management model to include overlapping relationships during the process of changing settings might lead to cost-effective outcomes. It is argued here that the current Israeli reform allows an opportunity to reconsider clients' needs and budget priorities, as doing so might lead to the development and implementation of appropriate discharge planning programs.