Reassessing "Jacob's case": a serial killer re-examined after ten years.

The current study re-examines an exceptional case of a serial killer incarcerated since a decade ago. "Jacob" is the first serial killer apprehended in Israel. His known actions were committed during the eighties of the last century, and continued for eleven years. The victims were elderly individuals, including both his parents. Shortly after incarceration he became overtly schizophrenic and underwent five hospitalisations. The case is re-examined in view of changes, both in the perpetrator's diagnosis and criminal legislation. Was Jacob doomed to become a serial killer, or could his fate be avoided through early professional intervention? Were the killings presenting symptoms of a psychotic or pre-psychotic phase? Should he be eligible for a retrial? What would have been his position with the current law in view of the new 300A(a) clause ("Reduced Punishment") of the Israeli Criminal Code? Could he ever be released back to the community? These are some of the questions to be addressed.

The "Jerusalem syndrome"--fantasy and reality a survey of accounts from the 19th century to the end of the second millennium.

The so-called "Jerusalem Syndrome" is behavioral phenomena observed in eccentric and psychotic tourists with religious delusions. A significant number of pilgrims and tourists have been visiting the Holy City, at least since the beginning of the 19th century, including some delusionary and eccentric characters. The authors present a selection of vivid descriptive accounts of such 19th century visitors, by six local residents and writers about Jerusalem (including one psychiatrist). It should be noted that those writers already noticed and documented the so-called syndrome more than a century ago. In comparison to modern research of the phenomena in contemporary Jerusalem, a striking similarity in the narrative and the clinical picture emerges. However, based on accumulated data, the authors suggest that in most cases the religious atmosphere of the city is not the primary cause for the disorder. The psychotic visitors had set out for their journey to the Holy City already guided by a delusionary system derived from their religious belief and cultural background.

[Impaired physicians: the Israel Intervention Program].

Diagnosis and treatment of mental disorders among physicians is a complicated problem. In western countries alcohol and drug abuse are the main mental problems of physicians, and programs of early treatment help them keep their practices without their harming their patients. We describe the activities of the Israel Committee for Psychiatric Examination of Physicians in 1989-93, when 115 physicians were examined. Addiction to alcohol or drugs was rare, but mental illness was detected in 50% of those examined. The results indicated that the committee acted therapeutically, dictating mental treatment and following up on it. Due to this policy, in most cases physicians were enabled and allowed to continue their practices. The results emphasize the need for occupational mental health facilities for physicians and other medical professionals.

Lack of effect of vitamin E on serum creatine phosphokinase in patients with long-term tardive dyskinesia.

Changes in serum creatine phosphokinase have been associated with exacerbation of tardive dyskinesia. Vitamin E, a drug suggested to be effective in the treatment of tardive dyskinesia, has been implicated as a possible cause of increased creatine phosphokinase levels. Ten patients with long-term tardive dyskinesia were treated with vitamin E in a double-blind, placebo-controlled crossover study. Vitamin E blood levels and creatine phosphokinase serum levels were monitored at various phases during the study. There were no significant differences between vitamin E and placebo treated patients in their abilities to affect tardive dyskinesia or to influence creatine phosphokinase levels. These data do not support the hypothesis that administration of vitamin E may alter creatine phosphokinase levels in patients with long-term tardive dyskinesia.

Psychiatric hospitalization of tourists in Jerusalem.

Every year some 50 tourists visiting Jerusalem are hospitalized following psychotic episodes. The majority of these patients are from religious backgrounds, and Jerusalem's special place in the Jewish and Christian religions appears to influence the nature of the delusionary experiences. This report examines the factors involved in this phenomenon.

Tourists and psychiatric hospitalization with reference to ethical aspects concerning management and treatment.

In this brief article, it is shown how tourists may decompensate psychiatrically upon arrival in a new country. Some of the factors that explain the background of some of these patients, and some of the ethical aspects concerning management and treatment are discussed.

Aryl sulfatase A deficiency in psychiatric and neurologic patients.

Two hundred ninety-five psychiatric and neurologic patients were randomly screened for aryl sulfatase A (ASA) activity in lymphocyte extracts. Two of these patients showed very low ASA activity, in the range of metachromatic leukodystrophy (MLD)-affected patients. The residual activity in these low ASA patients showed normal enzyme behavior with regard to ASA kinetic features and the ability to catabolize 14C labeled sulfatide by intact fibroblasts. Taking into account that approximately 3% of the general population are homozygous for the pseudo-aryl sulfatase A gene and are clinically unaffected, the data obtained here indicate that the patients studied in this work, as well as most psychiatric patients reported in the literature with low ASA activity, represent the normal ASA polymorphism. Thus, the very low ASA activity patients are in fact homozygous for the pseudo-deficient allele, which does not result in clinical abnormalities. The clinical symptoms in these psychiatric patients and probably other "variant" MLD patients are therefore not related to low ASA activity.

The effects of chronic lithium and ECT on A1 and A2 adenosine receptor systems in rat brain.

The influence of chronic dietary lithium administration and electroconvulsive therapy on adenosine A1 and A2 receptors in rat brain were determined. A2 receptor activity was measured by accumulation of cyclic AMP in a cerebral cortical slice preparation after in vitro addition of 2-chloro-adenosine, and was unchanged in animals which received chronic Li but reduced following chronic ECT. A similar reduction was found in the response to noradrenaline and a combination of the two agents. A1 receptors were measured by binding of [3H]cyclohexyladenosine. Both Kd and Bmax values were unchanged after chronic Li or a single ECS, but chronic ECT led to a 70% increase in Bmax. It is proposed that this effect may mediate the reduced locomotor activity seen after chronic ECT in rats, and that it may also be related to the increase in seizure thresholds seen during a course of ECS treatment in humans.

Immunologic reaction of psychotic patients to fractions of gluten.

Production of a leukocyte migration inhibition factor by peripheral blood lymphocytes in response to challenge with gluten fractions was studied in hospitalized patients with schizophrenia and other psychoses compared with normal individuals and with children and adolescents with celiac disease. The schizophrenic and other psychotic patients could be subdivided into two groups, one that responded in the leukocyte migration inhibition factor test as the celiac patients did and one that responded as the normal control subjects did. The psychotic and schizophrenic patients did not show any evidence of malabsorption. The authors speculate that gluten may be involved in biological processes in the brain in certain psychotic individuals.