Mental disorders in primary care in Israel: prevalence and risk factors.

OBJECTIVE: Psychiatric morbidity is common among patients in primary care services and leads to disability and increased use of medical services. Comparison of primary care and community prevalence data is of interest in relation to the health services planning for mental disorders. The aim of the present study was to measure prevalence of mental disorders in six primary care clinics in Israel and to assess risk factors for these disorders. METHOD: Prevalence of mental disorders was measured in a sample of 2,948 primary care consecutive attendees, using two-stage stratified sampling with the General Health Questionnaire 12 (GHQ-12) and the Composite International Diagnostic Interview (CIDI). RESULTS: A high rate (46.3%) of current mental disorders was found, with rates of current depressive episode, generalized anxiety disorder, somatization disorder, and neurasthenia being relatively high in comparison with rates in other countries. Low education was a risk factor for all categories of disorders, unemployment a risk factor for depressive disorders, and parenthood was protective for most categories of disorders. CONCLUSIONS: High rates of mental disorders were found in this Israeli primary care sample as compared to other countries, while in the community the rates were midrange as compared to other countries, pointing to a relatively higher use of primary care services by patients with mental disorders in Israel than in other countries.

Adolescents resisting treatment: exploring the resistance in eating disorder patients to treatment within the family system.

In the last three decades, the literature has supported the concept of conjoint family therapy for eating disorder patients. However, recently researchers have provided a more consistent focus on the individual in the context of seeing the family, turning to parent counseling and therapy especially when the patient resists therapy, at all ages. This development has come about due to the separation issues, the repetitive patterns of interaction about food and the need to understand the unconscious dialogue between parents and child as expressed through the eating disorder symptom. The aim of this paper is to present a family therapy model for eating disorder patients developed at the Davidson Clinic (Hanotrim). The model emphasizes the importance of separate treatment for the child and for her/his parents in the first stage of treatment. We shall discuss the importance of recruiting the parents into the therapeutic process, the powerful effect of parent group therapy and the father's crucial role in enabling the daughter's recovery. A case study that was conducted mostly with parents will illustrate the model.