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PubMedDate not supplied

Medical aspects of the Iraqi missile attacks on Israel.

During the period 18 January-28 February 1991, a total of 39 Iraqi modified Scud missiles landed in Israel, most of them in the densely populated Tel Aviv area. There were 23 missile attack alerts. These attacks caused 1,059 cases of injury; there were two deaths and 232 patients were admitted to emergency rooms for injuries directly related to the explosions, only one of which was severe. A survey among 91 of the injured showed that 46.6% of the wounds were caused by glass splinters, 31.1% were blunt contusions, and 22.2% were acute psychological reactions. No case of blast injury was reported. Inappropriate injection of atropine was reported in 230 cases. Acute anxiety was the reason for admission of 544 patients to emergency rooms. Another 40 patients sustained various traumas while rushing to the sealed room. The relatively low number of injured people is striking in view of the density of population in the areas hit. Various explanations are discussed.

Anxiety Disorders↗
PubMedDate not supplied

Helping patients to vote.

Explore the source record for details and available documents.

Attitude of Health Personnel↗
PubMed1999

Work characteristics predict psychiatric disorder: prospective results from the Whitehall II Study.

OBJECTIVES: The impact of work on the risk of future psychiatric disorder has been examined in few longitudinal studies. This was examined prospectively in a large epidemiological study of civil servants. METHODS: In the Whitehall II study, a longitudinal, prospective cohort study of 6895 male and 3413 female London based civil servants, work characteristics measured at baseline (phase 1: 1985-8) and first follow up (phase 2: 1989) were used to predict psychiatric disorder measured by a 30 item general health questionnaire (GHQ) at phase 2 and phase 3 follow up (phase 3: 1991-3). Work characteristics and GHQ were measured at all three phases. RESULTS: Low social support at work and low decision authority, high job demands and effort-reward imbalance were associated with increased risk of psychiatric disorder as assessed by the GHQ at follow up adjusting for age, employment grade, and baseline GHQ score. CONCLUSIONS: Social support and control at work protect mental health while high job demands and effort-reward imbalance are risk factors for future psychiatric disorder. Intervention at the level of work design, organisation, and management might have positive effects on mental health in working populations.

Adult↗
PubMedDate not supplied

[About the necessity of neuropsychological assessment in the civil law].

Giving expert opinions within legal psychiatry in civil cases requires more and more strict co-operation of expert psychiatrists with psychologists. Assessment of the cognitive functions with the help of neuropsychological methods is an important diagnostic element that leads to giving the right opinion. The most frequent reasons for appointing experts in psychiatry and psychology are disorders of cognitive functions as a result of various brain injuries. Dementia syndromes are particularly often subjects of doubts in preparing expert opinions as they must be distinguished from other organic dysfunctions and from the age--associated memory impairment. Considering the evidence value the most important thing is to assess all the objective data included in the medical records and subsequently to assess the testimony of the witnesses Usually people from legal circles and families of the people who make declarations of will overvalue the importance of additional examinations. Those examinations are important but they do not settle the patient's psychic state because the decisive factor is not the kind of somatic disease but the influence of that disease on the psychic state. The neuropsychologist's role in giving medical statements is going to increase together with the tendency to objectivization and qualitative assessment of intensification of respective disorders of cognitive functions when examining patients in order to give expert opinions.

Brain↗
PubMedDate not supplied

[Phototherapy: clinical and therapeutic evaluation of a 2-year experience].

The concept of seasonal periodicity in psychiatry has been studied for thirty years in different domains, particularly in that affective disorders. It seems to be established that winter seasonal depressions are correlated to a particular vulnerability to the decrease in ambient light; this led directly to the development of phototherapy as primary treatment of SAD, simultaneously to the development of the clinical concept. Since the first demonstration by Rosenthal of the efficacy of phototherapy in SAD, numerous studies have confirmed that bright light provides rapid and effective treatment for this type of disorder. Phototherapy has been used at the Centre Psychothérapique des Hôpitaux Civils de Colmar for five years in three ways: as an alternative treatment to medication, in addition to antidepressive medication, and as primary treatment of seasonal depression. We describe the evaluation protocol of this treatment, which was established in collaboration with the Psychiatric Clinic of the University of Basel. The principal inclusion criterion for this study was the presence or regular phases of depression or loss of energy in autumn and winter; the regularity of the appearance of symptoms in winter was predominant over the severity of the symptoms, their seasonal occurrence being the most important predictive factor in favour of phototherapy. Our prospective study enabled us to include, over a period of two years, 18 subjects presenting very different symptomatology. Though the sample was heterogeneous, the results of treatment efficacy are satisfactory: we note effectively a decrease of 67.5% in the modified Hamilton scale even though strict criteria for seasonality (Seasonal Screening Questionary, Rosenthal's Criteria) were not always respected. These data should lead us to widen the indication for phototherapy, particularly in patients presenting mood disorders which are not exclusively seasonal, and support the accumulating experimental data for the selective antidepressive effect of light.

Adult↗
PubMed1994

The Munchausen syndrome in civil forensic psychiatry.

The diagnosis of Munchausen syndrome requires that a patient intentionally produce or feign physical symptoms with a psychological need to assume the sick role. To differentiate the disorder from malingering one must document the absence of an external incentive for the patient's behavior. Although malingering is a major topic of interest in forensic psychiatry, there has been no literature that looks at the Munchausen syndrome presenting in the civil forensic setting. This paper reports on two cases of the Munchausen syndrome that occurred in the areas of medical malpractice and workers' compensation. The cases highlight how the psychiatrist should approach these cases in the civil forensic setting. The malpractice case also illustrates how the disorder is viewed by an appellate court.

Adult↗
PubMedDate not supplied

Are there therapies for bad cosmologies?

This paper explores geopolitics in terms of 'deep culture'--the assumptions and beliefs in the subconscious of individuals and in the collective subconscious, which are expressed in the ways nations and groups of nations relate to each other. One deep structure is the 'chosenness-myth-trauma' syndrome. Three structural reactions to mental disorder--sociotherapy, somatherapy and psychotherapy--are then applied to international relations. The possibility of collective therapy for a nation or group of nations is described.

Civilization↗
PubMed1998

The thrifty-genotype hypothesis and its implications for the study of complex genetic disorders in man.

According to the "thrifty-genotype" hypothesis proposed by Neel, diseases of civilization such as non-insulin-dependent diabetes mellitus and hypertension result from a discordance between certain features of our present-day environment and our genetic make-up which evolved to fit the life of Paleolithic humans. This concept implies that while "affected" individuals harbor the "original" ancestral version of the relevant genes, healthy or "unaffected" individuals have picked up recent mutations leading to a "loss of thriftiness" of these genes. Support for this concept now comes from recent studies of the angiotensinogen gene, where an ancestral variant of the gene (AGT 235T), also present in primates, has now been associated with hypertension whereas a neomorphic variant (AGT 235M) apparently reduces the risk of high blood pressure. The implications of these findings for our understanding and approach to the study of complex genetic diseases is discussed.

Angiotensinogen↗
PubMedDate not supplied

Unique patterns of comorbidity in posttraumatic stress disorder from different sources of trauma.

While there are many studies of comorbidity in combat veterans with posttraumatic stress disorder (PTSD), studies of PTSD from other sources of trauma (e.g., disasters, crimes, and civil violence) are just beginning to emerge. This is the first formal review comparing patterns of comorbidity in PTSD from different sources of trauma. Specific attention is given to the relative frequencies of substance abuse, depression, generalized anxiety, phobic, panic, somatization, psychotic, and personality disorders. The findings reveal that although similarities exist, the comorbidity profiles differ according to the type of trauma experienced and the population studied. Additionally, the evidence suggests that the associated psychiatric disorders are not truly comorbid, but are interwoven with the PTSD.

Adult↗