[Non-urgent compulsory hospitalization].

The Israel Mental Health Law of 1991 gave authority to the regional psychiatrist to give orders of compulsory hospitalization - urgent and non-urgent. The non-urgent Hospitalization Order applies to conditions of non-immediate danger, in which potential for significant damage or harm to the patient or others is expected. Authority is granted to the District Psychiatric Committee as a body of appeal (before the Hospitalization Order is carried out) and as a tribunal to decide upon continuation after the first two weeks of hospitalization. This article aims to stress the main problems encountered by psychiatrists regarding management and treatment under the Non-Urgent Compulsory Hospitalization Order: 1) Postponing hospitalization or releasing a patient for 24 hours, in order to launch an appeal before receiving any treatment, may facilitate clinical deterioration. The ambiguous waiting period could enhance anxiety, acting out and dangerousness. 2) The article discusses clinical and legal aspects of compulsory hospitalization - both urgent and non-urgent. The diverse problematic issues will be elaborated through three clinical cases, and, when clinically indicated, proposals raised for possible solutions in converting an urgent compulsory order to a non-urgent compulsory order.

[Legal involvement in psychiatric care].

In an amendment to the law regarding the treatment of the Mental Health patient in 1991, authority was given to the regional psychiatrists' committee to oversee compulsory orders for psychiatric hospitalization and compulsory orders for outpatient psychiatric treatment--and the extension of these orders. On 1st of June 2002 a pilot study was started in the Jerusalem region, in which mental health patients were to be represented by lawyers employed by the Ministry of Justice. The pilot study began as an initiative of the Ministry of Justice, in agreement with the Ministry of Health. We describe 3 cases which demonstrate that the procedure of legal representation lacks the necessary balance between medical and legal considerations. The decision of the regional psychiatrists' committee or the court is liable to worsen the patients' mental health status and even to accelerate aggression towards self or others. In rare cases a premature discharge based on legal considerations rather than medical evaluation may result in suicide, as demonstrated in one of the vignettes. The article discusses the unbalanced approach of legal versus medical consideration, preference of "liberty" over health and the "wish" of the patient rather than his well-being. The article considers the unbalanced approach of the legal system to appeals of therapists against the decision of the regional psychiatrists' committee, where prosecutors of the state decided an appeal of this kind over the staff treating the patient has no precedence. That was presented as justification that it should be rejected. A pilot study compared between patients discharged from compulsory hospitalization through regional psychiatrists' committee or court and patients discharged on a medical basis without legal interference. The study showed a shorter stay in the community in the first group (42%) compared to 75% stay in the community in the second group, after six months. We are of the opinion that the current provision of legal assistance is lacking the necessary balance between medical and legal considerations; the 'wish for freedom' as a default, although illogical, is within the new system of legal aid, and is more considerate and important than the 'best interests' of the patient and his health.

Imagination of body rotation can induce eye movements.

OBJECTIVE: Several studies have shown that spatiotemporal aspects of motion are stored and can be retrieved with the use of vestibular and somatosensory cues. The purpose of this study was to examine whether intentional imagination of body rotation can induce oculomotor activity similar to the typical vestibulo-ocular reflex (VOR). MATERIAL AND METHODS: Normal subjects without known vestibular and/or oculometric abnormalities were instructed to imagine a sensation of accelerating body rotation in the horizontal plane (rightward or leftward) while sitting in darkness with closed eyes, using only vestibular and somatosensory cues and not imaginary visual cues. Eye movements were recorded during the imagery session and also during a full, routine electronystagmography (ENG) test. All subjects selected for this study showed normal results in the ENG test, and none of them had gaze-evoked or end-point nystagmus. RESULTS: In response to imaginary rotations, horizontal eye movements were found in 91/121 recordings (75%) in 10 subjects. A typical pattern of nystagmus (0.3-3 Hz, 3-30 degrees /s maximal speed of slow component) was recorded in 53% of mental rightward rotations and 49% of leftward rotations. The fast component was always in the direction of the imaginary rotation (similar to a normal VOR). Other types of eye movement comprised either contralateral eye drift ( approximately 17% of trials) or macro square waves. In 25% of the recordings no definite eye movements could be detected during the mental maneuvers. CONCLUSION: These mentally induced eye movements seem to be due to a cortical process which can affect the normal input to the brainstem nuclei. A possible mechanism is discussed. This phenomenon may serve as an objective measurement of mental activity, may be used for testing the cognitive resources of patients and can probably be used for enhancing the rehabilitation process after acute vestibular insult.