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Background Attrition from mental health clinics is afrequent problem and has significant consequences for patients, families andfor the society. It has rarely been researched in Israel. We examined rates of attrition from 5 mentalhealth clinics and its reasons, from the perspective of dropouts and ofdirectors of psychiatric clinics and services. Methodology 179 dropouts and 171 patients who continuedtreatment filled questionnaires on socio-demographic and clinical data, attitudes to treatment and barriers, self-stigma and health. We also surveyedattitudes of 51 directors towards attrition. Main findings We found high attrition rates in all clinics. Main reasons for attrition from the perspective of the dropouts were no need oftreatment, bad/unhelpful treatment and problems with medications. Twopredictors were found: patients' report that the treatment approach was notappropriate and past compliance problems. Dropouts reported worse conditiontoday and were less in treatment. Directors estimated the dropout rate as lessthan half of the actual rate and did not speculate correctly its predictors. Conclusions Attrition is frequent in psychiatric clinics, but can be predicted. Disengagement fromtreatment predicts getting less treatment in the future. Attention is neededtowards the negative consequences of attrition and to ways to decrease it. [ABSTRACT FROM AUTHOR]

Background: Social Anxiety Disorder has been repeatedly shown to be very prevalent in the Western society with prevalence rates of 10% or above. However, very few studies have been performed in the Middle East and in Arab countries. Methods: Three hundred Israeli students participated in our study and were administered the Liebowitz Social Anxiety Scale (LSAS), the Cheek Buss Shyness questionnaire (CBSQ) and a socio-demographic questionnaire. Results: 153 Jewish and 147 Arab students participated in the survey. SAD was found in 12.33% of the sample, according to the LSAS cutoff score of ≥60. The two subsamples had similar LSAS and CBSQ scores and similar positive SAD-positive rates (LSAS≥60). Females had higher scores on the LSAS, as were those without a spouse and those that had been in psychological treatment. Based on a regression analysis, the significant predictors of the LSAS score were the CBSQ score and female gender. A very high correlation was found between the LSAS score and the CBSQ score. Conclusions: SAD and shyness are similarly prevalent in Jewish and Arab students in Israel. SAD scores were higher among females, those without a spouse and those that received psychological treatment. Further studies on the clinical and cultural characteristics of SAD in Israeli sub-cultures would add to the growing body of knowledge on SAD in various cultures. [ABSTRACT FROM AUTHOR]

The effects of antidepressant medication on suicide risk remain unclear. This study explores any association between antidepressant medication and suicide attempts leading to hospitalization in adult depressed patients.The medical records of 103 patients admitted after a suicide attempt were examined and compared with those of a matched control group of depressed patients (n = 103) admitted without suicide attempts as well as a patient group with and without suicide attempts on separate hospitalizations (n = 25). No significant difference in antidepressant medication exposure before hospitalization was found between groups. Selective serotonin reuptake inhibitor exposure was higher in patients with suicide attempts, albeit nonsignificant, but was identical in patients admitted on two occasions with and without suicide attempts. The most common method for suicide attempt was drug overdose (52.4%). Patients in the group with suicide attempts had significantly more past suicide attempts. Study results do not confirm any relationship between antidepressants and suicide attempts. Close monitoring of depressed patients is advised especially in early treatment.

There is growing evidence that individual differences among patients with major depressive disorder (MDD) on psychological and demographic measures may predict the therapeutic response to selective serotonin reuptake inhibitors (SSRIs). In this retrospective chart review, 108 outpatients with current major depressive episodes were treated with citalopram, paroxetine, or fluvoxamine. The Hamilton Depression Rating Scale and the Minnesota Multiphasic Personality Inventory-2 were administered before and after 8 weeks of SSRIs treatment. Clinical response was defined as a 50% or greater decrease in the 17-item Hamilton Depression Rating Scale total score (final visit minus baseline). This naturalistic short-term follow-up outcome study demonstrates that among depressive outpatients who responded to an 8-week trial, 57.4% achieved a good response to SSRIs. Statistical analysis showed that SSRI treatment may be 3.03 times more advantageous for MDD outpatients who are younger than 39 years. The patients with an elevated score of above 66T on the Social Introversion Minnesota Multiphasic Personality Inventory-2 scale are approximately 0.37 times as likely to be SSRI responders as are patients with a Social Introversion score less than 66T. Thus, it seems that in MDD outpatient age is the strongest predictor of response to SSRIs.

Background: Social anxiety disorder (SAD) has been repeatedly shown to be very prevalent in the Western society with prevalence rates of 10% or above. However, very few studies have been performed in the Middle East and in Arab countries., Methods: A total of 300 Israeli students participated in our study and were administered the Liebowitz Social Anxiety Scale (LSAS), the Cheek and Buss Shyness Questionnaire (CBSQ), and a sociodemographic questionnaire., Results: A total of 153 Jewish and 147 Arab students participated in the survey. Social anxiety disorder was found in 12.33% of the sample, according to the LSAS cutoff score of more than 60. The 2 subsamples had similar LSAS and CBSQ scores and similar SAD-positive rates (LSAS >60). Females had higher scores on the LSAS, as were those without a spouse and those who had been in psychological treatment. Based on a regression analysis, the significant predictors of the LSAS score were the CBSQ score and female sex. A very high correlation was found between the LSAS and the CBSQ scores., Conclusions: Although our sample is not representative of the whole Israeli population, we conclude that SAD and shyness were similarly prevalent in Jewish and Arab students in Israel. Social anxiety disorder scores were higher among females, those without a spouse, and those who received psychological treatment. Further studies on the clinical and cultural characteristics of SAD in Israeli subcultures would add to the growing body of knowledge on SAD in various cultures., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Providing treatment and support to special-needs populations can decrease psychopathology and suicide rates. Because service in the military is an important socializing force in Israeli society and most Israelis serve, the Israeli Defense Forces (IDF) makes special efforts to identify, treat, and support soldiers with emotional, behavioral, and cognitive problems. This column describes the IDF's efforts for three groups of soldiers with special needs, with a focus on those with the most severe problems who receive support throughout their service to address psychopathology and suicidality. Suicide rates for the IDF population and for the three groups are reported.

Objective: Self-injurious behaviours (SIBs) are widespread among prisoners and are sometimes classified as potentially calculated acts intended to control others. Access to a psychiatrist may be valued by imprisoned soldiers seeking immediate release from service. The main goal of the study was to assess the effects of a new mental health regulation in the Israel Defense Forces (IDF) prison system, which requires ordering an immediate interview with a psychiatrist for inmates performing SIBs., Method: Frequency of SIBs in 2 military prisons was examined and compared for 11 months before and 10 months after the implementation of the regulation. Severity of injuries and rates of release from service were examined for 4 months., Results: The frequency of SIBs significantly increased after the implementation of the regulation in one prison, but not in the other. No effect was found for rate of release from service or for severity of injuries., Conclusions: Increased accessibility to a psychiatrist for military prisoners may have resulted in increased motivation for inmates to perform SIBs. These effects are limited to the prison that serves a higher proportion of highly stressed soldiers.

Background: Social phobia (SP) is a highly prevalent disorder in Western countries, but is rather rare in Eastern societies. Prevalence rates range from 0.5% in Eastern samples up to 16% in Western studies. Its prevalence in Israel, an Asian state characterized by Western culture, has not yet been studied. The present study aimed to assess the prevalence of SP symptoms in a nonclinical sample of Israeli adolescents, to characterize sociodemographic correlates of SP symptoms and to evaluate comorbidity with specific phobia symptoms., Methods: Participants included 850 young soldiers from the Israel Defense Forces. Measures included the Liebowitz Social Anxiety Scale (LSAS; self-report version), a questionnaire on specific fears and phobias, and a sociodemographic questionnaire. Clinical and demographic correlates of SP were also examined., Results: Probable SP (LSAS >or=80) was present in 4.5% of the sample. Overall, SP symptoms were reported by a great percentage of the subjects, as displayed by the rather high mean LSAS scores (29; SD = 23.79) in this nonclinical sample. The following variables were accompanied by higher LSAS scores according to our regression model: inability to perform command activities, receiving psychotropic medication before army service, having less than two friends, shy family members, and treatment during military service. Subjects with probable SP had a rate of comorbidity with specific phobia symptoms of 44%., Conclusions: Our findings corroborate those from other studies in Western countries, both regarding the high prevalence of SP symptoms and its demographic and clinical correlates, as well as regarding the high overlap rate with specific phobia symptoms.

Background: The threat of the potential spreading of the SARS epidemic caused significant stress to many individuals from non-affected countries. In this study, we investigated whether the SARS threat affected the subjective mood and behavior of Israeli patients with schizophrenia and compared their reactions with those noted in their clinical staff., Methods: Subjects were evaluated with a specially designed questionnaire and a modified form of the Spielberger Scale for State Anxiety., Results: As compared to staff, patients had higher scores on the Modified Spielberger State Anxiety Scale. However, many responses (e.g., dysphoria) to the SARS threat did not differ from staff. Patients felt more protected by the authorities and some perceived the epidemic in a psychotic manner., Conclusions: It seems that patients attempt to reduce the effect of external stressors by living in an "autistic bubble" (in which outside threats cannot enter) or by denying the significance of these stressors and over-emphasizing the power of medical authorities to protect them. On the other hand, some patients also psychotically interpreted these stressors.

During a period of four years, multidrug-resistant Escherichia coli of particular serotypes have been isolated from 255 elderly (>65 years) patients from four hospitals in central Israel. 83% of the isolates belonged to one of four predominant serotypes (O153:H31, O101:H-, O2:H42, and O102:H6). All isolates were producers of extended spectrum beta-lactamases and resistant to ciprofloxacin. To our knowledge, the involved serotypes have hitherto not been reported as etiological agents of extraintestinal human infections (MEDLINE). Pulsed-field gel electrophoresis of isolates from one of the most frequent serotypes indicated a clonal relationship between them. Further investigation of these strains and analysis of their virulence factors may help to confine their spread.

Enteroaggregative Escherichia coli (EAEC) is a newly diarrheagenic agent wherein several predominant serotypes are reported. We studied the association between those serotypes, as clonal indicators, and the trait of enteroaggregative adherence to host cells, tested by polymerase chain reaction. We also evaluated the clinical manifestations of infection in 17 hospitalized children by our most common EAEC serotype, O126:H27.

Background: Depression is a common, under-recognized disorder that causes a great burden on the individual, the family and the community. Depressive symptomatology has serious effects on the psychological and medical condition of patients, and also disrupts their well-being and daily activities. The aim of the present study was to investigate the prevalence of depressive symptomatology in the Israeli population, and its relation to demographic variables and perceived health., Methods: A random sample of 937 Israeli adults filled out the Beck Depression Inventory (BDI) together with a demographic questionnaire., Results: 21.5% scored positively for depressive symptomatology (BDI > 9). 3.8% reached a BDI score in the range of severe depression. Female gender, old age, lower education, immigrant status, manual work and lower income were associated with increased rates of depressive symptomatology. Poor perceived health was also associated with depressive symptomatology., Conclusions: The rates of depressive symptomatology in this study are similar to those found in other studies, performed mostly in Western countries. Despite several methodological limitations, we conclude that the rate and the demographic risk factors of depression in Israel are similar to that of other developed and Western countries.

Objective: The authors assessed the attitudes of military physicians and mental health officers regarding the phenomenon of malingering., Method: Questionnaires on attitudes regarding malingering and possible cues indicative of deception were sent to 115 general practitioners (GPs) and mental health officers (MHOs) in the Israel Defense Forces (IDF)., Results: 91 responses were received--a response rate of 80%. All the respondents claimed that they had seen cases of malingering. They estimated that every fourth soldier is malingering. GPs claimed that they had seen more cases of malingering as compared to MHOs. Those who estimated that malingering is very frequent in the military, also had higher estimates of malingering in their civil work. The most indicative clues of malingering among soldiers were inconsistency, flamboyant complaints, exaggeration of symptoms and accentuation of secondary gain., Conclusions: Among IDF GPs and MHOs, there currently appears to be moderate consensus regarding the frequency of malingering and its characteristic signs. The study provides further support to the notion that malingering is an important clinical phenomenon. We believe that the issue merits further research and scrutiny.

The current psychiatric literature emphasizes the important risk factors of suicide and parasuicide, which include the following: age, family status, psychopathology, substance abuse, biological markers and so forth. Recently, more emphasis has been placed on the yearly distribution of suicide and parasuicide. This distribution includes parameters such as national and religious holidays, birthdays, anniversary days, the lunar cycle and weather. It has been suggested by many researchers that this distribution is an important precipitant to a cumulative and complicated psycho-pathological process, terminating in suicidal behavior. Analysis of theories and research findings regarding these topics are provided, together with suggestions for research and prevention.

An emerging literature suggests that posttraumatic stress disorder (PTSD) patients are at an increased risk for suicide. The objective of this study was: a) to reexamine the relationship between PTSD and suicide by comparing suicide risks of persons with PTSD, to persons with anxiety disorder and to matched controls; and b) to examine the relationship between anger, impulsivity, social support and suicidality in PTSD and other anxiety disorders. Forty-six patients suffering from PTSD were compared with 42 non-PTSD anxiety disorder patients and with 50 healthy controls on measures of anger, impulsivity, social support, and suicide risk. Persons with PTSD had the highest scores on the measures of suicide risk, anger, and impulsivity and the lowest scores on social support. Multivariate analysis revealed that in the PTSD group, impulsivity was positively correlated with suicide risk and anger was not. PTSD symptoms of intrusion and avoidance were only mildly correlated with suicide risk at the bivariate level but not at the multivariate level. For the PTSD and anxiety disorder groups, the greater the social support, the lower the risk of suicide. For the controls, social support and impulsivity were not related to suicide risk, whereas anger was. These findings suggest that persons with PTSD are at higher risk for suicide and that in assessing suicide risk among persons with PTSD, careful attention should be paid to levels of impulsivity, which may increase suicide risk, and to social support, which may reduce the risk.

One of the central tenets of the Druze religion is the transmigration of the soul. In rare cases this belief may be related to psychopathology or cause a temporary inability to function normally. We report on 5 Druze patients whose preoccupation with transmigration was the basis of their pathological behavior. These cases illustrate the interaction between cultural and religious beliefs, and psychopathology, and emphasize the importance of employing a culture-specific psychiatric approach in the management of this type of patients.

Attempted suicide in adolescence is a major health problem and recent reports indicate a dramatic increase in the frequency of attempted and completed suicide among adolescents. The aim of this study was to evaluate the characteristics of adolescent admissions with attempted suicide in a large general hospital. The files of all children and adolescents admitted due to a suicide attempt between the years 1984 and 1994 were examined retrospectively, with regard to age, sex, method of attempt, season, year and length of hospitalization. Four hundred and four admissions with attempted suicide were recorded. The majority (83.7%) were females and drug overdose was the most common (92.8%) method used. Thirty patients (7.5%) repeated the attempt during the study period. No specific time of the year was associated with an increase in adolescent suicide attempt admissions. The most remarkable finding was that younger adolescents had a higher probability of performing a violent suicide attempt. Hypotheses for these trends are examined together with possible ramifications for treatment provision.

Transmigration of souls is one of the central beliefs of the Druze religion and culture. However, in rare cases this belief can represent psychopathology. A case of an 18-year-old Druze soldier suffering from generalized anxiety disorder whose presenting symptom was a belief in transmigration of souls is described. This case illustrates the interaction between cultural and religious beliefs with psychopathology.

We assessed eating attitudes and body image using the Eating Attitudes Test-26 (EAT: Garner & Garfinkel, 1979) and a 17-item body image scale in Israeli Jewish female high school populations in five distinct residential settings (kibbutz, moshav, city, and 2 different boarding schools); in five ethnically distinct Arab female high school populations (Muslim, Christian, Druze, Circassian, and Bedouin); and in a group of hospitalized adolescent girls with anorexia nervosa. We hypothesized that the attitudes of the adolescent females most exposed to Western body shape ideals and simultaneously undergoing role conflict between traditional and modern images of the female role would most resemble attitudes of anorectics. This was partly supported by the findings. Ethnic differences also emerged in attitude toward food. All the Arab populations except the Circassian showed strong Western influences in their attitudes toward eating and body image and thus may well be prone to epidemics of anorexia and similar eating disorders in the near future. Kibbutz girls were most similar to the anorectic group.

A combined plan of action of the Medical Corps in the battle against traffic accidents is described. The plan covers sound medical standards for military driver licensing, disqualification of drivers with medical problems, reporting of problematic drivers (epileptics and others) to the Israeli Ministry of Health, evaluating the driving fitness of drivers involved in traffic accidents, and finally, an education program for all Israel Defence Forces soldiers to be delivered by military physicians. Several medical aspects of traffic safety are highlighted. Scientific research and greater involvement of physicians and psychologists in this area is required if the trauma occurring daily on highways is to be eliminated and acute care hospital costs minimized.

Anorexia nervosa is a psychiatric disorder characterized by excessive dieting, severe weight loss, disturbed body image and inexplicable fear of gaining weight. It afflicts mainly upper class women of developed countries. We present a 16-year-old recent immigrant from Russia, where she had developed anorexia nervosa, obsessive-compulsive disorder and depression. The management of this patient is presented in the light of the sociocultural theory of the pathogenesis of anorexia nervosa and the clinical link between eating disorders and depression and obsessive-compulsive disorders.