Raz Gross

Healing environment in psychiatric hospital design.

Mental health professionals have long speculated that the physical environment in which treatment occurs has an impact on both the treatment process and its outcome. The few empirical studies that evaluated the effects of psychoenvironmental design have shown encouraging results and demonstrated clinically desirable behavioral changes and even reduced psychopathology. In view of the concept that architecture is a tool in the therapeutic process, the design and execution of the psychiatric hospital in the Chaim Sheba Medical Center at Tel-Hashomer, Israel, were conducted by a multidisciplinary team of architects, mental health professionals, and administrators. The hospital contains three acute inpatient wards and a day care and large outpatient clinic. Its operation began in 1991. This paper deals with the merging of user-friendly architectural and environmental design components that create an integral healing environment. The paper discusses the positive effects of specific components on patients and staff, and suggests that our model of psychoenvironmental approach to psychiatric hospital design can provide an important and effective tool in the pursuit of a humane, efficient containment and reduction of severe psychopathology.

Cancer in parents of persons with schizophrenia: is there a genetic protection?

A reduced risk for cancer has been noted among persons with schizophrenia as well as their first degree relatives. One explanation for these findings suggests that genes associated with schizophrenia confer reduced cancer susceptibility. Given the well documented genetic factor in schizophrenia it could thus be expected that cancer incidence rates should be lower in persons with schizophrenia with a known family history of schizophrenia compared to persons with sporadic schizophrenia, as well as their first degree relatives. This study investigated the risk for cancer among the biological parents of persons with schizophrenia accounting for the familial aggregation. Linkage was conducted between national population, psychiatric and cancer databases. Standardized incidence rates for all cancer sites were calculated by comparing the parents rates with those of the general population. In addition, the association between familial aggregation of schizophrenia and risk for cancer was calculated among the parents. A reduced cancer risk was found among the parents compared to the general population (SIR 0.8, 95% CI 0.8-0.9). However, no evidence of decreased risk was associated with familial schizophrenia. Thus, no association between familial aggregation and cancer incidents was found with regard to most cancer sites. Moreover, a small, but not statistically significant increased risk of colon cancer was associated with familial aggregation scores among the parents (OR 1.2, 95% CI 1.0-1.5). These findings undermine the support to the genetic explanation for the reduced risk for cancer in schizophrenia among patients and their biological parents.

Status inconsistency and common mental disorders in the Israel-based world mental health survey.

ObjectiveResearch on status inconsistency (SI) and its impact on mental health has been dormant for many years. This study tested the association between SI and emotional distress, anxiety and mood disorders.MethodsData were gathered from the Israel-based component of the World Mental Health Survey (nxa0=xa04,859). SI was defined by the combination of high education (13+ years) with low income (1st decile). Mood and anxiety disorders were diagnosed with the composite international diagnostic instrument (CIDI), and emotional distress was measured with the 12-item general health questionnaire (GHQ-12).ResultsMultivariate analysis showed increased risk for mood or anxiety disorders among SI subjects (nxa0=xa0231), odds ratio (OR)xa0=xa01.75, 95% confidence interval (95% CI) 1.13–2.63. The estimate was slightly attenuated when marital status was added to the model (ORxa0=xa01.55, 95% CI 1.0–2.39). SI subjects showed higher GHQ-12 scores.ConclusionSI, which can disrupt an individual’s sense of coherence, is associated, although not causally, with increased 12xa0month prevalence rates for mood or anxiety disorders and with higher psychological distress.

“Schizo-Obsessive” Subtype: Obsessions and Delusions

The comorbidity of schizophrenia and obsessive-compulsive disorder (OCD) might be approached from two different directions. One is the OCD with psychotic features, and the other is the schizophrenic patient with OCD.