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Biomedical subjects

Y Ginath

Publications and source records attributed to Y Ginath.

At least 37 records · Page 2Linked to original sources

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.

Adolescent↗

Genetic epidemiological study of schizophrenia: reproduction behaviour.

Data from the Tomsk Epidemiological Register and epidemiological family sample were used to study the relationship between schizophrenics' reproductive behaviour (marital status and fertility rate), severity of ICD-9 schizophrenia and risk of illness among relatives of probands. The results are interpreted in terms of multifactorial threshold and single monolocus models. Their importance for the interpretation of epidemiological data (a change of prevalence rate, cohort effect and clinical polymorphism) is discussed.

Adult↗

Improving psychiatric environments through minimal architectural change.

Minimal architectural changes in a treatment environment can lead to significant improvements in how the setting functions, with positive effects for staff, patients, and families. When a mental health center located in an antiquated hospital in Jerusalem added five additional entrances, the change improved accessibility, increased the sense of freedom, and helped define the identity of the units. Other therapeutic effects were obtained from minimal modifications in a day hospital unit, including brightening paint and changing lighting, reopening a separate stairway for use by patients not enrolled in the day unit, and defining separate living, dining, and personal-expression areas within the common room. The authors note that cooperation between the disciplines of architecture and psychiatry is essential and that the idea of change as a continuous process should be incorporated into an organization's culture.

Architecture↗

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.

Acculturation↗

[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.

Antidepressive Agents, Tricyclic↗

Propranolol in the treatment of akathisia caused by antipsychotic drugs.

We have reported the case of a patient with neuroleptic-induced akathisia who had rapid amelioration of his symptoms after treatment with the highly lipophilic beta-blocker propranolol. His symptoms had previously failed to respond to traditional pharmacologic treatment. There is clearly a need for more double-blind studies to assess the efficacy of propranolol and other beta-blockers in the treatment of this troublesome side effect of antipsychotic medications.

Adult↗

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.

Adult↗

[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.

Adult↗

The reliability of psychiatric diagnosis in Israel's Psychiatric Case Register.

To determine the reliability of psychiatric diagnoses in the Israel Psychiatric Case Register, DSM-III criteria were applied to case record abstracts of first admissions to a large psychiatric hospital in Jerusalem. The DSM-III diagnoses were compared with ICD-8 records diagnoses. Between 40 and 50% of those originally diagnosed as schizophrenia were re-diagnosed into less severe categories. The proportion diagnosed as affective disorder doubled from 21% for ICD-8 diagnoses to 40% for DSM-III diagnoses. The unreliability concerned the diagnoses of schizophrenia and affective disorder. Findings suggest that the introduction of standardized diagnostic criteria in Israel will lead to a substantial increase in the number of cases diagnosed as affective disorder, although difficulties involved in differentiating schizophrenia from the major affective disorders remain. The DSM-III findings suggest a high prevalence of affective disorders among Jews.

Adolescent↗

The "Münchausen syndrome" in aesthetic surgery of the nose: the patient's problem or the surgeon's problem?

The case history of a patient who searched for years for an unattainable facial appearance is presented. Over a fourteen-year period, the patient consulted 13 plastic surgeons and underwent 10 surgical procedures on his nose and chin. Only at a very late stage was he examined by a psychiatrist. This consultation revealed evidence of Münchausen syndrome--named after the famous Baron of Münchausen and introduced to modern medical literature by Asher in 1951. Asher's publication enlightened many physicians, enabling them to treat such cases with better understanding. The repeated unsuccessful operations in such cases leads one to believe that further surgery will fail to solve the patient's psychiatric problems. Moreover, in a patient showing evidence of this syndrome, approval of the desired operation by a surgeon further strengthens the patient's belief in the legitimacy of his delusions.

Adult↗

Justifying inpatient admissions at a community mental health center.

A model for screening and reviewing inpatient psychiatric admissions at a community mental health center is presented in which the process, including the use of both a diagnostic criteria set and a functional criteria scale, is described. Results of a time-limited experimental program indicated that the diagnostic criteria set could be applied in approximately three fourths of the admissions, while the scale of function could be utilized in all cases. Also, a statistically high rate of concordance was found both when the two methods were used by the same evaluator, and when two independent evaluators were employing the same method. At the conclusion of the final review, 6 of 273 admissions or 2.2 per cent were unjustified. The pilot program demonstrated that 90 per cent of the admissions could be screened adequately by nonphysicians. The average time expended by in-house staff including screeners, reviewers, and supportive staff was estimated to be 58.4 minutes per admission with an average direct cost per case of $6.68. Had the review been performed by physicians in local practice, the average cost per case was estimated to be $8.93. The six unjustified admissions represented an average reviewing cost of about $240 per case.

Adult↗