An epidemiologic study of Gilles de la Tourette's syndrome in Israel.

OBJECTIVES: The goal of this study was to estimate the lifetime prevalence of Gilles de la Tourette's syndrome (GTS) in adolescents aged 16 to 17 years. DESIGN: Population-based epidemiologic study. SUBJECTS: Eighteen thousand three hundred sixty-four males and 9673 females aged 16 to 17 years screened for induction into the Israel Defense Force. RESULTS: Of the 28,037 individuals screened, 12 met diagnostic criteria for GTS. The point prevalence in this population was 4.3 +/- 1.2 (mean +/- SE) per 10,000. The 95% confidence interval for this estimate is 1.9 to 6.7 per 10,000. The point prevalence was 4.9 +/- 1.6 per 10,000 for males (95% confidence interval, 1.8 per 10,000) and 3.1 +/- 1.8 per 10,000 for females (95% confidence interval, 0 to 6.6 per 10,000). The rate of obsessive-compulsive disorder (OCD) was significantly elevated among the subjects with GTS (41.7%) compared with the population point prevalence of OCD (3.4) in those without GTS. In contrast, the rate of attention deficit hyperactivity disorder was only 8.3% compared with the population point prevalence of 3.9% in those individuals without GTS. CONCLUSIONS: The prevalence estimates from this population-based study are in agreement with previous results based on surveys of younger children. The sex ratio observed in this study is not as large as reported in previous studies and remains to be explored in other studies of adolescents and adults.

Obsessive-compulsive disorder with and without tics in an epidemiological sample of adolescents.

OBJECTIVE: This study was undertaken to discriminate subtypes of obsessive-compulsive disorder in adolescents. METHOD: Forty individuals with obsessive-compulsive spectrum disorders were ascertained from an epidemiological sample of 861 adolescents. Interviews were conducted by child psychiatrists using semistructured diagnostic interviews, including a clinician-rated Yale-Brown Obsessive Compulsive Scale. Discriminant analysis was performed to compare the scores on the Yale-Brown scale of groups with and without comorbid tics and to compare boys and girls. RESULTS: Adolescents with tics were more prone to aggressive and sexual images and obsessions than were adolescents without tics; these differences could not be wholly attributed to sex differences. CONCLUSIONS: The subtypes among unreferred adolescents are similar to those of adult patients with obsessive-compulsive disorder with and without Gilles de la Tourette syndrome. Subtypes evident in adulthood may be established relatively early in the natural course of obsessive-compulsive disorder.

An epidemiological study of trichotillomania in Israeli adolescents.

OBJECTIVE: To determine the prevalence of trichotillomania and comorbid psychopathology in nonreferred adolescents. METHOD: Using a questionnaire and interview, 794 Israeli 17-year-olds were screened for current and past hair-pulling and comorbid psychopathology. RESULTS: Eight current or past hair-pullers (5 male, 3 female) were identified, yielding a lifetime prevalence of hair-pulling of 1%. Four subjects reported current hair-pulling (point prevalence of 0.5%). None of these reported alopecia, distress, or tension before pulling; only two reported relief after pulling. Thus, none met the full DSM-III-R criteria for trichotillomania. Four subjects reported past but not current hair-pulling, with bald spots in two cases. Three of the four current hair-pullers had significant obsessive-compulsive symptoms, a significantly elevated rate compared to the entire screened population. Two subjects with obsessive-compulsive disorder also had generalized anxiety disorder and, in one case, chronic simple vocal tics. Hair-pullers did not differ significantly from non-hair-pullers in IQ, physical fitness, and overall competency, or prevalence of other comorbid disorders. CONCLUSIONS: In a community adolescent sample, only 25% of hair-pullers reported resulting bare spots and none endorsed both rising tension and subsequent relief. The prevalence of obsessive-compulsive symptoms was significantly elevated in these nonreferred hair-pullers.

Suicide in the Israeli army.

The present study was an attempt to analyze the problem of suicide in the Israel Defense Forces (IDF). Suicide is increasing among populations aged 18-21, which in Israel is the age when most young people are called up for a 3-year period of compulsory military service. The service may have a catalytic effect on suicide. but on the other hand may serve as a control mechanism reducing suicide. The study used data for the period 1974-1985, and examined suicide in combat and noncombat units by duration of service and by preservice psychiatric, medical, and motivational data. The suicide groups were also compared with a matched sample of nonsuicide groups along the relevant variables. The findings seem to be consistent with some established theoretical perspectives of situational stress, social support, and status incompatibility, and seem to bear practical implications for the reduction of suicide.

A unique monthly distribution of suicide and parasuicide through firearms among Israeli soldiers.

The monthly distribution of completed suicide and parasuicide by Israeli soldiers was analyzed during the 7-year period of 1984-1990. Although parasuicide in general showed a constant incidence throughout the year, the monthly rate of suicide as well as parasuicide through firearms varied during the year in a similar way. The seasonal pattern of completed suicides, the vast majority of which occur with firearms, was correlated with the seasonal pattern of parasuicides through firearms. The combined variability of the two seasonal patterns was found to be significantly different from a pattern of a constant monthly incidence with a peak in December and a nadir in October. The monthly incidence of suicide and parasuicide through firearms was found to be negatively correlated with the duration of the daily photoperiod, when the latter was phase-advanced by 1-2 months. This unique pattern of seasonal incidence of suicide and parasuicide through firearms is different from most of the patterns reported in the Northern Hemisphere.

Psychiatric implications of missile attacks on a civilian population. Israeli lessons from the Persian Gulf War.

OBJECTIVE: To determine the proportion of hospitalized patients who had stress reactions as a result of missile attacks during the Persian Gulf War and evaluate the factors that influenced their evacuation. DESIGN: Review of medical records of patients hospitalized as a result of missile attacks. SETTING: During the Persian Gulf War in the winter of 1991, Israel received 18 missile attacks involving 39 surface-to-surface Scud missiles. The uncertainty in time, place, and type of warhead, conventional or chemical, was a source of chronic stress and the immediate cause for many traumatic stress reactions at or near the missile attack sites. PARTICIPANTS: Data from victims who were injured after each missile attack were available through a central hookup between 12 local hospitals and the Medical Corps of the Israeli Defence Force. MAIN OUTCOME MEASURE: The number of persons diagnosed in the hospital as psychological casualties after each missile attack. RESULTS: Approximately 43% of the 773 casualties evacuated to hospitals were diagnosed as psychological casualties, and an additional 27% had mistakenly injected themselves with atropine. Data also indicated that triage of psychological casualties to hospitals was more a function of the rescue team's training and preparation than the severity or extent of injury or damage. CONCLUSIONS: Optimal treatment during events that cause mass casualties requires proper preparation of rescue teams as well as reorganization of the hospital's psychiatric services. The threat of chemical warfare affected the number and nature of stress reactions.