Enforced psychiatric treatment of minors in Israel: the interface between the Mental Health Act and the Youth Law.

Proposed changes in the current Youth Law will provide enforced psychiatric treatment, including civil commitment, for "at risk" minors. Such minors are considered at significant risk of future developmental damage without such treatment. The potential exists for a clash between the proposed criteria for enforced psychiatric treatment in the Youth Law and the existing criteria in the current Mental Health Act: "need for treatment" in the former versus "immediate and physical danger to self or others as a result of psychotic illness" in the latter. Proposed changes in the Mental Health Act include broadening the criteria for enforced psychiatric treatment of minors. The revised criteria would include non-psychotic emotional disorders (such as recurrent suicidal behavior) which endanger the minor's physical and emotional development. These changes are welcomed. The authors suggest the adoption of "need for treatment" criteria, as against the current "physical danger to self or others" criteria for enforced psychiatric treatment of minors.

Involuntary psychiatric hospitalization of minors.

Hospital records of the psychiatric hospitalization of minors living in the south of Israel were studied retrospectively for age, diagnosis and legal status on admission. The records of those minors who were involuntary hospitalized were investigated for behavioural symptomatology and justification for involuntary hospitalization. A range of psychiatric diagnoses was found, excluding diagnoses of schizophrenia and bipolar affective disorder. Explanations for these findings are offered.

Aggressiveness in subjects referred for examination by court order: a retrospective study (1988-90) in the southern district of Israel.

Two hundred and eighty cases examined by court order by the district psychiatry office in the southern district of Israel in the past three years (1988-90) were critically reviewed. Analysis of the monthly distribution of criminal acts throughout the year shows a specific pattern of monthly occurrence of aggressive criminal acts (annual rhythm). This rhythm shows peaks in February and the summer months (June, July, August) and nadirs in March, October, November and December. The monthly occurrence of non-aggressive criminal acts showed a different pattern as compared with the annual rhythm of aggressive criminal acts. A correlation was found between the annual rhythm of aggressive criminal acts and the annual photoperiod (day length) rhythm. There was a significant positive correlation between these rhythms. We also analysed the age dependent distribution of aggressive criminal acts. A continuous age dependent increase in the percentage rate of aggressiveness was found.

Dysphoria in the elderly.

Evidence is presented for distinguishing a clinical entity characterized by dysphoria associated with physical impairment, isolation and financial and social disadvantage in the elderly in residential care. Personality factors are believed to play a considerable part in the aetiology of the condition. A distinction is made between similar groups of elderly persons, in one of which dysphoria is associated with depression and a group of non-depressed, dysphoric individuals.

Elderly persons in old-age homes. A medical, psychiatric and social investigation.

A survey of 100 consecutive admissions to homes for elderly Whites in Cape Town showed that an interplay of social, physical and psychiatric factors was responsible for most of the referrals, although psychiatric factors contributed to more than 50% of them. The largest proportion (37%) suffered from confusional states, 31% were diagnosed as having a senile organic condition and 25% showed moderate to severe depression. These old people were physically very frail; 53% had incapacitating muscular weakness or stiff and painful joints, 35% had a significant degree of deafness, 25% had a visual defect and 23% were incontinent. The findings indicate that old-age homes deal with a considerable amount of physical and mental ill health, and they are therefore an essential part of health services. The residents of old-age homes were much older than elderly people in the community, as well as being more socially isolated and very disadvantaged in terms of income and family and social support.

The admission of the elderly to places of care: a socio-psychiatric community survey.

Elderly persons over the age of 60 who were admitted for psychiatric care were compared with a random sample of persons living in the same community in respect of psychiatric, medical and socio-economic variables. The group admitted to hospital for psychiatric reasons was very similar to the latter in general characteristics. However, those people admitted to old age homes, which are the other major resource of psychiatric illness, constitute a distinctly separate population, being older and having considerably more physical illnesses and socio-economic problems. Factors predicting admission to an old age home were largely irremediable age-related conditions (dementia, physical infirmity, etc.), but there were also adverse social circumstances, including marked isolation and a lack of social and emotional support. A comparative analysis of the many psychiatric, social and medical factors is presented, with particular reference to reasons for referral and prevention of admission.