The Jerusalem psychiatric mother-baby unit.

The Jerusalem mother and baby unit (MBU) is influenced by the psychoanalytical orientation of the staff, and the historical and cultural conditions surrounding the unit. Forty-three patients with 44 babies (one set of twins) were admitted in 13 years, a rate of admission far from the theoretical demand. Schizophrenia, schizoaffective disorder and mood disorders have been the major diagnoses in more than 50% of the patients. Mothers with schizophrenia were significantly more likely to be admitted sooner after the birth than mothers without schizophrenia (p = 0.025). One infant was separated from the mother on discharge and four recommendations for adoption were given.

The fitness of the mental patient to be a witness.

The determination of whether a patient has criminal responsibility or is able to stand trial is routine psychiatric work. Cases in which we- psychiatrists- are asked to express our opinion on whether a patient can testify, however, are quite rare. We shall attempt to clarify some of the issues relating to the testimony of mentally ill patients through a case presentation. In this case, the Court agreed to consider our patient's testimony, only after receiving our expert opinion. We find that the Court's reversal of its original decision and its willingness to consider the testimony of a mental patient in the same trial in which he was initially found unable to stand trial, marks an important precedent. The question of the credibility of the mental patient as a witness has significance beyond this case concerning mental patients' rights in regard to the judicial system. We believe there is a need for further discussion between psychiatrists andjurists regarding the fitness of the mental patient to testify as a witness.

[Treating mother and baby in conjoint hospitalization in a psychiatric hospital].

Since 1990 we have been admitting mothers with postpartum psychiatric morbidity together with their babies to our open psychiatric ward. The aim of conjoint hospitalization is to maintain and develop the bond between mother and baby while treating the mother's psychiatric disorder. The presence of the infant in the hospital allows both a thorough evaluation of the mothers' maternal ability and to use the infant as a facilitator of the mothers' recovery by engaging maternal functions. It prevents the infants from being placed in a foster home for the duration of the mothers' hospitalization. Readily available in Britain and Australia, such conjoint hospitalization is controversial and rarely available elsewhere. In the past 5 years we hospitalized 10 women with 11 babies (1 woman was hospitalized twice, after different births). All women had received psychiatric treatment prior to childbirth, but this was the first psychiatric hospitalization for 2 of them. Diagnoses (DSM-IIIR) were chronic paranoid schizophrenia (4), affective disorder (4), schizo-affective schizophrenia (1) and borderline personality disorder (1). 8 were suffering from active psychotic symptoms on admission. They were treated pharmacologically, received individual and group psychotherapy, and participated in all ward activities. Families were engaged in marital, family and/or individual therapy according to need. All participated in cognitive-behavior treatment tailored to individual need to build and enrich the mother-infant bond. All improved significantly and were able to function independently on discharge, but in 1 case adoption was recommended.

[Risperidone-induced priapism].

Priapism or pathological, prolonged erection, is a rare adverse effect sometimes associated with psychotropic medication and is due to alpha adrenergic receptor blockade. Priapism in a 44-year-old mental patient receiving risperidone is described. Urinary retention was relieved by catheterization, followed by saline irrigations. Priapism was relieved when a hematoma was evacuated from his penis. This may be the first description of priapism following risperidone alone, since a previous report included a patient receiving risperidone together with 2 other psychotropic medications. Priapism should be looked for in men receiving risperidone, a novel antipsychotic medication.

Admissions to a psychiatric hospital during the Persian Gulf War.

A descriptive study of all the admissions to a psychiatric hospital in Israel during the first month of the persian Gulf War was carried out. There was no decline in the number of admissions, and all the admitted 31 patients were civilians. War-related symptoms were manifest at the admission of 12 patients. Delusions of war-related content were prevalent, sometimes with corresponding hallucinations; three cases with these features are described briefly. There appeared to be an over-representation of female patients whose families originated in the Persian Gulf area. These findings may help in the planning of psychiatric services for similar future emergencies.

[Overlap between schizophrenia and affective disorders--a family study].

The distinction between schizophrenia and affective disorders is fundamental. However, overlapping has been described in most studies of schizophrenia and of affective disorders. We studied 20 families, each with at least 1 parent and 1 child with a diagnosis of schizophrenia or of affective disorder. In half the families there were 2 diagnoses. In most of these families the children had a more severe disorder than the sick parent, onset was earlier, more were diagnosed as schizophrenic, hospitalizations were longer, and social functioning was worse. The results emphasize current problems in psychiatric diagnosis, which still lacks a pathophysiological etiologic basis.

[Substance abuse among mental patients].

Abuse of alcohol and other drugs by mental patients has been reported extensively in the past decade, especially in the USA. It has seemed to us that drug abuse has become more common among mental patients treated at this psychiatric hospital and at outpatient clinics in Jerusalem in recent years. Therefore, 100 patients admitted consecutively were questioned with regard to alcohol and drug abuse. A quarter of the male patients were diagnosed as having both a psychiatric disorder and drug abuse. Drug abuse was even more common among male schizophrenics aged 26 to 35, but only 2 reported alcohol abuse. Drugs used were mainly opiates (heroin and methadone) and hashish, and in most cases both. The results indicate that mental patients, especially young men with schizophrenia, may be another risk group for drug abuse in Israel.

Folie à trois among two Soviet-Jewish immigrant families to Israel.

In two cases of folie à trois, affecting two Soviet-Jewish families who emigrated to Israel, both elderly parents in both cases shared the paranoid delusional beliefs of an only child. Severe trauma in the past and social maladjustment in the present may be among the precipitating factors for the development of the shared paranoid disorder.

Trazodone-induced mania.

Two bipolar depressed patients and one unipolar depressed patient developed manic symptoms after receiving trazodone. The symptoms resolved when the treatment was discontinued or reduced. We believe the two bipolar patients are the first cases of this reaction reported in the literature.

Tumor sponge implantation: an in vivo method for studying syngeneic, primary antitumor lymphocyte responses.

Sponge matrices surgically implanted in the s.c. space of the back of normal BALB/c mice were injected with a "regressor" dose of Moloney virus-induced BALB/c tumor cells. The kinetics of the generation of cytotoxic cells within the sponge was studied over a 22-day period in a short-term 51Cr release assay. Cytotoxic activity peaked on Day 16 and then declined to negligible levels by Day 22. No cytotoxicity was detectable when nontransformed BALB/c blast cells, Moloney leukemia virus-induced tumor (LSTRA) cells, or unrelated chemically induced tumor (EL4) cells were used as targets. When the cellular composition of implanted tumor sponges was examined on Day 16, it was found to be 30 to 40% myeloperoxidase-positive cells, 15 to 25% surface immunoglobulin-positive cells, and 40 to 50% theta-positive cells. Treatment with anti-Thy 1.2 plus complement eliminated the cytotoxic response on Day 16. The ratio of T-cells to tumor cells within the sponge was determined by immunofluorescence. Kinetic studies showed that the number of theta-positive cells increased well before cytolytic activity was detected, possibly reflecting increasing numbers of amplifier T-cells or cytotoxic cell precursors. A later decline in theta-positive cells correlated directly with decreased cytotoxicity. Furthermore, onset of cytotoxic activity also correlated with a decline in the percentage of Moloney murine sarcoma virus tumor cells within the sponge. Sponge cells isolated on Day 16 (peak cytotoxicity), mixed with lethal dosages of moloney murine sarcoma virus tumor cells, successfully neutralized the lethal challenge demonstrating the in vivo antitumor efficacy of these effector cells. Sponges were also implanted in mice which had been immunized with single injection of Moloney murine sarcoma virus cells. Inoculation of the sponge with tumor cells resulted in a second set response in which cytotoxic cells appeared much earlier than in unsensitized animals. Cells from spleen, lymph node, or peritoneal cavity of normal or presensitized animals with tumor sponge implants were not cytotoxic, suggesting a highly localized response.

Incidence and significance of recurrent focal segmental glomerulosclerosis in renal allograft recipients.

Renal transplantation was performed in 25 patients for renal failure secondary to nephrotic syndrome and histologically proven segmental glomerulosclerosis (FSGS). They received 33 allografts, 13 from cadaveric (CAD) and 20 from living related donors (LRD) including 6 HLA-identical siblings. All have been followed for at least 1 year with none lost to follow-up. Overall, functional graft survival of the 33 grafts was 68.7% at 12 months and 60.5% at 48 months, similar to controls matched for age, sex, time of transplant, and donor source. Recurrent FSGS was documented histologically in 9 (5 CAD and 4 LRD) of 33 grafts (27.3%) and resulted in loss of graft function in 3 (9.9%). The presence and extent of mesangial proliferation (MP) in conjunction with or preceding typical lesions of FSGS in native kidneys was predictive of recurrent disease. Age at onset, duration of disease, and donor source were not. Sixteen patients with only FSGS on multiple biopsies of native kidneys received 22 allografts and recurrent disease occurred in 4 (18%) but did not cause loss of graft function in any. Six patients with focal areas of MP as well as FSGS underwent eight transplants, in which recurrent FSGS developed in two (25%) and caused graft loss in one. All three grafts transplanted to the patients with diffuse MP and FSGS developed recurrent disease, this resulting in graft failure in two. This study demonstrates the importance of a thorough histological evaluation by multiple biopsies of all patients with steroid-nonresponsive nephrotic syndrome. Only in this manner does it appear possible to define that subgroup of patients with FSGS who are at greatest risk of clinically significant recurrent disease.