Does Specializing in Family Medicine Improve the Detection and Diagnosis of Mental Health Problems?

Background: Approximately half the patients seeking mental health (MH) treatment consult primary care practitioners (PCPs). Previous research indicates that patients often do not receive correct MH diagnoses or appropriate treatment from PCPs. The present study examines whether a specialization in family medicine compared to other or no PCP residency programs enhances physicians' ability to detect, diagnose and treat MH problems.

Physicians' influence on primary care patients' reluctance to use mental health treatment.

Objectives: The study examined attitudes of primary care patients toward mental health treatment and whether ambivalent or negative attitudes change after patients receive recommendations from their primary care physicians to seek treatment from a mental health professional.

Methods: Data were collected in face-to-face interviews with 902 Jewish patients aged 25-75 in eight primary care clinics in Israel. Measures included validated mental health instruments and a vignette eliciting patients' readiness to consider treatment and potential influence of a physician's recommendation.

Use of unconventional therapies by primary care patients--religious resources vs. complementary or alternative medicine services.

Objectives: The study examines the difference in characteristics between primary care patients who turn to "religious resources for medical purposes" (RRMP) and those who turn to "complementary or alternative medicine" (CAM) services to cope with a physical or mental health problem.

Design And Setting: Data were collected from eight primary care clinics in Israel and included 905 Jewish patients aged 25-75.

Main Outcome Measure: A self-report questionnaire with a battery of validated mental health assessment instruments and two questionnaires regarding use of unconventional therapies (RRMP and CAM services) were administered to the participants.

Hospitalization of patients with schizophrenic and affective disorders in Israel in the aftermath of the structural and rehabilitation reforms.

Background: In the last decade (2001-2010) the Ministry of Health implemented two major inter-related reforms: a 'structural reform' to reduce the number of psychiatric beds and the 'Rehabilitation of the Mentally Disabled in the Community Law', which allocated funds for a variety of residential and vocational programs in the community for these patients. The objective of the present paper was to examine the impact of the two reforms on the hospitalization of schizophrenic and affective disorder patients by tracking the patterns of their inpatient care during the last decade.

Methods: Data on all psychiatric admissions during the period 1990-2011 were extracted from the Israel Psychiatric Case Register to examine changes in the rate of admissions, length of hospitalizations, total inpatient days and tenure in the community.

Trends in the use of rehabilitation services in the community by people with mental disabilities in Israel; the factors involved.

Background: In 2001, the Rehabilitation of the Mentally Disabled Law was implemented, defining a basket of rehabilitation services to which people with mental disabilities are entitled.

Objectives: To describe change over time in the characteristics of applicants to rehabilitation committees, types of referral agencies, and the proportion of those referred who were admitted. To identify factors affecting implementation of decisions to admit people with mental disabilities into different rehabilitation services and predictors of the length of time they remain in the services.

Who gets mental health treatment from the GP? Results from the Israel National Epidemiological Mental Health Survey.

Background: In view of the pending mental health (MH) reform, an increase in demand of MH services is expected. Primary care physicians will presumably be involved in meeting this expected increased demand.

Objectives: To identify the preferable route of service use of populations with MH problems based on data from the Israel National Health Survey (INHS).

Dropout from outpatient mental health care: results from the Israel National Health Survey.

Objectives: To examine the dropout rates from outpatient mental health treatment in the general medical and mental health sectors and to identify the predictors of dropout.

Method: The study population was extracted from the Israel National Health Survey. The analysis was related to 12-month service utilization for mental health reasons.

Predictors of early psychiatric rehospitalization: a national case register study.

Background: Inconsistent results have been published on variables affecting readmission to psychiatric hospitals, in particular length of hospitalization before discharge. The objective of the present study was to develop a predictive model for 30 days readmission after discharge, as the latter is one of the performance indicators in the pending mental health reform in Israel.

Method: The data were extracted from the Israeli national psychiatric case register.

Predictors of cumulative length of psychiatric inpatient stay over one year: a national case register study.

Background: Prior studies have shown inconsistent results regarding predictors of length of stay (LOS) and of readmission in psychiatric hospitals. “Cumulative LOS” over a given period, which reflects both LOS and readmission, has not been examined so far in a systematic way. The Israel Psychiatric Case Register in Israel made it possible to examine predictors of Cumulative LOS in a nationwide, representative sample.

Post-discharge contact with mental health clinics and psychiatric readmission: a 6-month follow-up study.

Background: Continuity of mental health care is a major topic in the post deinstitutionalization era, especially concerning its possible importance as a contributing factor in preventing rehospitalization.

Objectives: To examine a) the association between continuing care and time to rehospitalization; and b) the predictors of time to first outpatient contact after discharge from psychiatric hospital.

Methods: Hospitalization records of all patients discharged from the Tirat Carmel psychiatric hospital in Israel, between January 1, 2006, and December 31, 2006, the National Register of Psychiatric Hospitalizations database and administrative databases of all psychiatric outpatient clinics in this catchment area were used to monitor continuing care and rehospitalization within 180 days from discharge.

Employment among persons with past and current mood and anxiety disorders in the Israel National Health Survey.

Objective: The study examined associations between having a past or current mood or anxiety disorder and being employed in the past month and salary level.

Methods: The Israel National Health Survey used data from the National Population Register to compile a representative sample of noninstitutionalized residents aged 21 and older. Data for this study were from 4,859 persons interviewed in their homes between May 2003 and April 2004.

Estimating the changes in demand for public mental health services following changes in eligibility: analysis of national survey data.

Background: Numerous national surveys have shown that the rate of use of mental health services in a population lags behind the prevalence rate of psychiatric disorder. The preparations to provide universal coverage in Israel require estimates of the utilization levels likely to be reached once mental health care becomes a legal right of each resident.

Aims: This paper aims to provide an estimate of the size of the population which not only will be eligible for specialty mental health care, but which will also demand ambulatory mental health specialty care from public providers

Methods: Data for this study were extracted from a national survey conducted during 2003-2004 in Israel as part of the WMH2000 initiative.

Twelve-month service utilization rates for mental health reasons: data from the Israel National Health Survey.

Objective: To measure the 12-month utilization rates for mental health reasons in all types of services.

Method: A representative sample extracted from the National Population Register of non-institutionalized residents aged 21 or older were interviewed at their homes between May 2003 and April 2004. DSM-IV disorders were assessed using a revised version of the Composite International Diagnostic Interview (WMH-CIDI).

Prevalence of mood and anxiety disorders in the community: results from the Israel National Health Survey.

Objective: To estimate the 12-month and lifetime prevalence rates of mood and anxiety disorders in Israel and their socio-demographic correlates.

Method: A representative sample of respondents extracted from the National Population Register of non-institutionalized residents, aged 21 or older, were interviewed at home between May, 2003, and April, 2004. DSM-IV disorders were assessed using a revised version of the Composite International Diagnostic Interview.

Prevalence and risk factors of threshold and sub-threshold psychiatric disorders in primary care.

Objective: Prevalence rates of mental health problems in primary care vary according to population and the type of measure used. This study examined the prevalence of a full range of mental health problems, including sub-threshold diagnoses, and the socio-demographic risk factors for psychiatric disorders among a population with low out-of-pocket expenditures for medical care.

Method: Four validated mental health assessment instruments, including the CIDI-SF, were administered to a sample of 976 users of primary care in Israel between the ages of 25-75 in eight clinics throughout the country.

Re-hospitalization of first-in-life admitted schizophrenic patients before and after rehabilitation legislation: a comparison of two national cohorts.

Background: In line with the worldwide trend of deinstitutionalization and development of community facilities, a rehabilitation legislation was passed in Israel in 2000. Its aim was to establish an infrastructure for the chronic mentally ill. The objective of the present study was to evaluate the impact of this legislation on the re-hospitalization of schizophrenic patients.

Impact of a rehabilitation legislation on the survival in the community of long-term patients discharged from psychiatric hospitals in Israel.

Background: The aim of the present study was to examine the impact of the Rehabilitation Law 2000 in Israel (which provides a basket of rehabilitation services for every mentally disabled patient) on the survival in the community of a population of long-stay psychiatric patients released from psychiatric hospitals.

Methods: A naturalistic follow-up study was performed on long-stay patients discharged ("key discharge") from two Israel psychiatric hospitals closed before (in 1997) and after (in 2000) introduction of the Rehabilitation Law 2000. The data source was the National Psychiatric Hospitalization Registry.

Reduction in inpatient length of stay and changes in mental health care in Israel over four decades: a national case register study.

Background: The purpose of the present study was to investigate trends over the past 40 years in the accumulated length of hospital stay, and to consider how these trends might have been affected by changes in the provision of mental health care in Israel from 1960 to 1997.

Methods: The national psychiatric case register was used to follow four cohorts of all new admissions in 1960, 1970, 1980 and 1990 diagnosed with schizophrenia or affective disorders for the first seven years following the index admission.

Results: Most of the changes in length of stay occurred among patients with schizophrenia.

Neuroleptic Malignant Syndrome: Neuroleptic Rechallenge After Electroconvulsive Therapy.

The necessity of neuroleptic rechallenge in patients who have experienced neuroleptic malignant syndrome (NMS) has been discussed in recent articles. Electroconvulsive therapy (ECT) has been proposed as an alternative treatment to neuroleptics. In cases where ECT fails, neuroleptic rechallenge remains the only alternative.