The efficacy of naltrexone in preventing reabuse of heroin after detoxification.

The efficacy of Naltrexone in preventing reabuse of heroin among heroin addicts in Israel was studied in a double-blind, controlled design. Naltrexone (or placebo) treatment was given as part of a general treatment plan that continued for 12 weeks. Thirty-two addicts who successfully completed a detoxification program and met research criteria, were included in the study. Fifty milligrams of Naltrexone were taken orally three times a week (25 mg twice a week for the first 2 weeks). The follow-up procedure included an interview, urine tests, and screening for possible adverse effects. In addition, social and psychological parameters were evaluated. Fewer heroin-positive urine tests were found the Naltrexone group than in the placebo group. Throughout the entire study, the number of drug-free patients in the Naltrexone group was higher than in the placebo group. The Naltrexone group showed a significant improvement in most psychological parameters as compared with the placebo group. No differences were found in compliance or ratio of adverse effects between the Naltrexone and placebo groups. The concept "heroin abuse load" based on daily heroin consumption and duration of addiction enabled us to predict which addicts would complete the treatment program. The results suggest that heroin addicts in Israel may benefit from treatment with Naltrexone.

Relatedness of schizotypal personality to schizophrenic disorders: multifactorial threshold model.

Genetic analysis of schizophrenia and schizotypal personality disorder (SPD) was conducted on two pedigree samples. The results are interpreted in terms of a multifactorial threshold (MFT) model. A high rate of schizophrenia was found in relatives of both samples, but any excess of SPD was found only in relatives of the SPD sample. Based on these data, the hypotheses assuming a single liability with two thresholds (Reich's model) and different liability (Smith's model) for both disorders were rejected. The coefficient of genetic correlation is 0.61. Our data suggest that schizophrenia and SPD are separate nosological entities and that some of the factors which constitute liability to SPD influence the development of schizophrenia, but not vice versa.

Evaluation of compulsory ambulatory treatment in Israel.

The effectiveness of Israel's compulsory ambulatory treatment order was evaluated based on a one-year follow-up of the 326 orders served during the first four years of implementation. Demographic, epidemiological, clinical, and legal data were obtained from patient records. Success was defined as continuous treatment for the entire six-month period of compulsory ambulatory treatment, or as voluntary hospitalization during or after the compulsory treatment period. The compulsory ambulatory treatment order was found to be efficacious in 43.3 percent of the cases; in 32.5 percent it did not succeed in preventing compulsory hospitalization, and in the remaining cases (22.1 percent), success was partial.

Psychological distress among Ethiopian and Russian Jewish immigrants to Israel: a cross-cultural study.

A community survey was conducted examining the differences in levels of psychological distress and its symptomatology, comparing 110 Ethiopian-Jewish and 400 Russian-Jewish immigrants to Israel. Psychological distress was measured by the Talbieh Brief Distress Inventory. Russian immigrants were found to be more distressed than their Ethiopian counterparts and this between-group difference can be attributed to the greater relative number of females, older immigrants and those with longer duration of stay in Israel in the Russian sample. The highest levels of distress were observed for paranoid ideation in the Ethiopian sample and anxiety and hostility in the Russian sample. These symptoms were independent of gender and time since immigration. Russians with longer duration of stay demonstrated higher scores signifying adjustment difficulties than their Ethiopian counterparts. These results suggest that the differences in levels and symptom expression of psychological distress are determined, to a considerable extent, by demographic factors (sex, age) and the differing cultural backgrounds of the two immigrant groups.

Suicide ideation among recent immigrants: an epidemiological study.

This paper reports preliminary results of an epidemiological survey of suicide ideation among recent adult immigrants from the former Soviet Union to Israel. The study presents one-month prevalence rates of suicide ideation, and the relationship of suicide ideation with demographics, self-rated psychological distress, depression, emotional isolation and social support. Results show that the one-month prevalence rate of suicide ideation in the population is 16.9%. Suicide ideation was most frequent among socially and emotionally isolated immigrants with lower social support. The strongest predictor of suicide ideation for both sexes was level of psychological distress, whereas the severity of depression predicted suicide ideation only in females. The findings can be used as a point of departure for the development of suicide prevention programs.

The psychological profile of Jewish late adolescents in the USSR: a pre-immigration study.

Psychological well-being and the level of psychological autonomy were studied in a group of 109 Jewish late adolescents in the USSR. The subjects were not found to be more distressed than their American peers, but their dependency on their parents was significantly higher. The findings are discussed in the light of Soviet social values and child rearing attitudes and their impact on the adjustment of Soviet immigrant adolescents in Israel.

Predicaments of the closed ward staff.

Coordinated team work is a sine qua non for efficient functioning of a therapeutic ward. Extreme violence on the part of a patient may disrupt the working relationship within the team to the extent of causing its members to question their choice of profession. Physical assaults and allegations of professional or personal misconduct brought forward by a patient and his/her family may undermine the competence of the attending staff. Recognition by the health, legal and psychiatric authorities of the difficulties to which the personnel on an acute closed ward is continually exposed may alleviate staff burnout. This in turn will contribute to better management of the patients.

Electro-encephalography spectral analysis of heroin addicts compared with abstainers and normal controls.

UNLABELLED: Previous studies have shown that opiates slow the EEG and, in high doses, reduce the threshold of seizure activity. The present work looks at computerized EEG analyses (in the Fast Fourier Transform-FFT-method) of heroin addicts, recent abstainers and normal controls, with the aim of comparison and delineation of group characteristics. Examinations of 60 taped EEG recordings were performed: 20 subjects were current heroin users, 20 were recent abstainers and 20 were normal controls. Statistical analysis was performed for the relative frequency of wave bands. To amplify the known findings of slowing in heroin users, specific ratios were calculated: the alpha ratio (namely, the 8.0-9.5 Hz to 9.5-12.0 Hz ratio) and the delta to low alpha ratio. The specificity and sensitivity of the FFT method were evaluated through the use of discriminant analysis. The EEG was also recorded on conventional paper and evaluated by a neurologist. RESULTS: The addicts had a higher alpha ratio. The abstainers had a slowing of their alpha waves, a high incidence of delta waves and a delta to low alpha ratio that was relatively high. As a function of time from the beginning of abstinence, this ratio decreased. Abstainers for more than 80 days and controls had identical EEGs. The FFT method had 50% sensitivity for the addicts and 70% for the abstainers, while the specificity was 55%. In contrast, the neurologist's reading of the EEG had a very low sensitivity (25% for the addicts, 30% for the abstainers and 20% for the controls) and a 70% specificity.

Psychological adjustment among Soviet immigrant physicians: distress and self-assessments of its sources.

The purpose of this study is to examine the psychological distress of Soviet immigrant physicians in Israel and their self-assessed sources of this distress. The subject of this study included 385 (152 men and 233 women) Soviet immigrant physicians who had participated in preparatory licensing courses. The investigation shows that women have higher scores of distress than men in Global Stress Index of the Brief Symptom Inventory and its subscales which reflect anxiety. A comparison of Global Stress Index of the subjects of this study with U.S. and British published non-patient norms shows a significantly higher distress level among the immigrant physicians. Most of the respondents evaluated their psychologic state before immigration to Israel as better (303 or 78.7%). These assessments are found to be directly dependent on the stress load of the respondents at the time of the interview. Perception of the sources of absorption difficulties and distress scores are also found to be in close dependence. The results of the multiple regression analysis indicate that both sex and distress are statistically significant predictors of immigrants' estimation of their difficulties. However, it is the level of distress that has the greatest influence on the assessments of the respondents.

Psychological adjustment and distress among Soviet immigrant physicians: demographic and background variables.

The goal of the present study was to examine the psychological distress of Soviet immigrant physicians in Israel and to identify risk and resilience factors in the psychological adjustment to immigration. This is a first report on a study conducted among 385 (152 men and 233 women) Soviet immigrant physicians who participated in preparatory licensing courses. The design of the study is described in detail and initial results are presented. These include demographic characteristics of the sample, background variables connected with motivation for immigration and reported absorption difficulties encountered in Israel. Family problems were found to be significantly correlated with depression: the highest rate of reported depression was found among single parents. Subjects who were examined during the second year after immigration reported depression more often than subjects who were in Israel less than a year. The findings suggest that motivational and family factors may enhance or mitigate the psychological distress experienced by immigrants.

Who is to protect the rights of hospitalized mental patients?

The 1991 Treatment of Mentally Sick Persons Act contains a large section on the rights of hospitalized mental patients. However, mental patients are often ignorant of their rights, have difficulties gaining access to outside support and are hence unable to materialize their rights and protect them. Who is to protect their rights? The various individuals and groups which play a role in protecting the civil rights of mental patients are listed and discussed: patients themselves, family members, human rights organizations, legislators, courts, the state comptroller, the media and therapists. The introduction of another institution, non-existent in Israel, a 'patient advocate' (ombudsman) is suggested and discussed.

Report of the committee assigned to investigate the protection of hospitalized mental patients against sexual assault and abuse--a critical review.

On 7 March 1991 a special committee was nominated by the Deputy Minister of Health to investigate the protection of mental patients hospitalized in Israel against sexual assault and abuse. The committee reached the conclusion that '[t]here were cases of sexual assault and abuse' but avoided examining the frequency of such cases. The committee interpreted the Israeli criminal law to mean that no patient has the ability to give consent to sexual relations, thus every incident of sexual relations with a patient has to be considered to be rape, that is the total responsibility rests on hospital staff. The inevitable recommendation was to convert all the psychiatric wards in Israel to unisexual wards. This article contains a critical review of the report. The main arguments brought forward are: (a) Most psychiatric wards in Israel are open, a fact that makes separation meaningless. Since the mixing of the wards both sexual and aggressive behaviour has been significantly reduced. (b) Many, if not most inpatients are voluntary and if brought to court would be found to be responsible for their actions, including their competence to give consent for sexual relations. (c) Patients, like everybody else, adjust their behaviour to the expectancies of society. The message that they are irresponsible will have a detrimental effect on their behaviour. (d) It is the staff's duty to prevent patients who may later regret their sexual behaviour from having sexual relations. This can be done without separating the wards.(ABSTRACT TRUNCATED AT 250 WORDS)

[Lithium carbonate augmentation in tricyclic antidepressant-resistant depression].

Combinations of lithium carbonate and tricyclic antidepressants are effective in the treatment of resistant unipolar depression. We present a case in which addition of lithium carbonate to a maximal dose of desipramine provided rapid and sustained improvement in a severely depressed 57-year-old woman. She had previously failed to respond to maximum doses of antidepressant drugs of 2 different classes. Although the lithium-tricyclic combination was successful in our case, we caution against its routine use.

[Lithium-associated alopecia].

A 39-year-old woman who developed alopecia shortly after treatment with lithium carbonate was initiated is described. The alopecia resolved 2 months after lithium was discontinued. Though this side-effect is relatively rare, we suggest that patients getting lithium for short or long term treatment be monitored for it.

The criminal liability of the mental patient in Jewish law (Halacha).

The legal status of the mentally impaired has been dealt with in Halachic literature since the third century. This article presents four Halachic viewpoints regarding the exemption of the mentally ill patient from legal responsibility in tort and criminal law: lack of mental awareness; lack of free will; lack of judgment; categorial personal status. Halachic legislations with regard to the liability of the insane predate the criteria as applied by modern psychiatry. The similarities between the Halachic and contemporary medicolegal approaches are presented.

[Bromocriptine-associated postpartum psychotic exacerbation].

2 cases are presented in which bromocriptine (Parlodel) was administered to suppress physiological lactation; parturition had precipitated deterioration in mental status and psychotic behavior. Discontinuation of bromocriptine and administration of antipsychotic medication resulted in gradual improvement in the psychotic symptoms, without complications of galactorrhea or breast engorgement. We recommend that changes in mental status be looked for when bromocriptine is given.

A look at court appointed psychiatric evaluations in Israel with special reference to criminal liability.

This article presents the data collected from 128 court appointed psychiatric evaluations (CAPEs) and their analysis. Issues addressed are: the link between type of criminal offence and mental disorder; rate of recidivism; efficacy of the early detection and follow-up systems; inherent psychiatric dilemmas; unacceptable lacuna in information recorded in the CAPEs; and the babel of legal and psychiatric terms. We advocate that a combined effort be made by the legal and psychiatric fraternities to create a uniform and standardized CAPE.

[Compulsory, ambulatory psychiatric treatment].

The Treatment of Mentally Sick Persons Law of 1955, was repealed and replaced by the Law of 1991. Under the latter, the Order for Compulsory Ambulatory Treatment (OCAT) was addressed for the first time (Section 11, a-d). According to this law, the district psychiatrist instead of issuing a hospitalization order, may issue an OCAT, under which the required treatment is given within the scope of a clinic which he designates, for up to 6 months and under conditions which he specifies. This is done on the basis of psychiatric examination, or an application in writing from the director of a hospital or clinic, when continued ambulatory treatment is needed after discharge from hospital or instead of compulsory hospitalization. The district psychiatrist may extend the period of treatment for further periods, none of which is to exceed 6 months. Compulsory ambulatory treatment is to enable patients to benefit from the positive aspects of living freely in the community, while receiving prompt treatment under compulsory conditions. The concept offers a partial solution, achieving a balance between civil liberties and clinical needs, between over-confinement and under-treatment which might be dangerous or neglectful. The clinical impression has been that the OCAT has not fulfilled expectations. The purpose of this study was to examine the topic in a systematic way in Jerusalem and the southern districts for the 4 years since inception of the law. In 44.4% of cases OCAT was proven to be effective, while in 33.1% it was found to be ineffective and did not prevent compulsory hospitalization, one of its main goals. It was partially effective in the rest of the cases. It is recommended that suitable means for the enforcement of the law be allocated and that the subject of forceful hospitalization and OCAT be made a mandatory subject in the residency program of psychiatrists.