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Correspondence BRITISH JOURNAL OF PSYCHIATRY 2000), 176, 492^498 Correspondence the UK have to adjust to working in colla- boration with other teams in the area and never aspire to providing a service for an EDITED BY LOUISE HOWARD entire catchment area, as Thornicroft et aletal Contents && CommentsonComments on JerusalemsyndromeJerusalem syndrome && Effectiveness of intensiveintensivetreatment treatment 1999) have emphasised. Both Marshall etet in severe mental illness && Antidepressantchoice to minimise treatment resistance alal and Sashidharan et aletal have failed to note && Depression andandinterferon-alpha interferon-alpha therapy && Sluggish economics affect health of that standard community care has im- proved enormously in the past 20 years Japanese`business warriors' && Assessment and discharge following deliberate self-harm and therefore can compete successfully with && Ambient iodine and lithium-associated clinical hypothyroidism && ConsentConsentin in mandatory formal assertive approaches, including both homicide inquiries && Medicalrolesin mentalhealth review tribunals && Possible ACT and intensive case management. Un- neuroleptic malignant syndrome with quetiapine like drug/placebo comparisons, in which the effects of placebo are roughly similar whatever the year, complex psychosocial Comments on Jerusalem syndrome with Jerusalem syndrome. Nikolai Gogol interventions such as those in a mental suffered from manic depression, severe health service are changing constantly. I As the authors of several articles on hypochondriasis and physical ailments, can predict with some confidence that the Jerusalem syndrome Bar El et aletal, 1991;,1991; and he set out to Jerusalem acts of pilgrim- Cochrane reviewshowingsuch excellent Witztum & Kalian, 1999), we would like age were widely encouraged in tsarist Rus- findings with regard to superiority of ACT to add our comments to the paper by Bar- sia) hoping to alleviate his long-standing in randomised controlled trials Marshall ElEl et aletal 2000). If epidemiological data suffering Witztum et aletal, 2000).,2000). et aletal, 1998) will show steadily decreasing supporting Bar-El et aletal's typology exist, it benefits of ACT in future revisions. This is is regrettable that they were not presented Bal El, I.,Witztum, E., Kalian, M., et aletal 19 91) not because ACT has suddenly lost its effec- in their article. To our knowledge, such Psychiatric hospitalization of tourists in Jerusalem. tiveness; standard treatments have caught data have not been found in previous Comprehensive Psychiatry,, 3232, 238^244.,238^244. up immensely in the past fewyears and studies Bar El et aletal, 1991). The psychiatric Bar-El,Y., Durst, R., Katz, G., et aletal 2000) Jerusalem have done so often by using different ap- hospitalisation of tourists in Jerusalem is syndrome. British Journal of Psychiatry,, 176, 86^90. proaches to those of the original ACT pro- uncommon around 50 patients per year, Parshall, A. M.19 1995) 9 5) Controversy over psychiatric grammes. The statement of Sashidharan etet from among almost two million tourists). tourism. British Medical Journal,, 311311,1567.,1567. alal 1999) that contemporary psychiatric The condition is much less prominent than Tannock, C. & Turner,T.19 1995) 95) Psychiatric tourism is care ``continues to be dominated by think- problems faced by local services in other overloading London beds. British Medical Journal,, 311,, ing and practices which have their origin 806.806. major cities Parshall, 1995; Tannock & in the last century'' is a travesty of the cur- Turner, 1995). Contrary to some `dooms- Turner,V.Turner,V. 1973)1973) The center out there: the pilgrims' rent position and a slur on the reputation goal. History of Religion,, 1212,191^210. day' predictions, so far, there has been no and performance of many dedicated com- significant increase in the rate of tourist Witztum, E. & Kalian, M.1999) The `Jerusalem munity mental health teams across the syndrome' ^ fantasy and reality. A survey of accounts hospitalisations due to the newmillennium. from the 19th century to the end of the second country. Such teams have cause for congra- In our view, perhaps Jerusalem syndrome millennium. Israel Journal of Psychiatry,, 3636,260^271., 260^271. tulation. Even though they are deprived of should be regarded as a unique cultural the resources that are allotted to ACT, par- __ && __ 2000) The quest for redemption: reality and phenomenon because of its overwhelming fantasy in the mission to Jerusalem. In Israel as ticularly the requirement of a case-load of theatrical characteristics Witztum & Centrestage: A Setting for Social and Religious Enactments only 8±12 clients per worker, they are un- .eds P.P.A.Hare A.Hare & G.M.Kressel).Westport:G. M.Kressel).Westport: Greenwood. Kalian, 2000). Such dramatic qualities have doubtedly effective and may even have a been reported by various biographers since __ , Lerner,V. & Kalian, M. 2000)2000) Creativity and positive effect on reducing suicide and insanity: the enigmatic medical biography of Nikolai the establishment of pilgrimage and tour- Gogol.Gogol. Journal of Medical Biography, in press.press.,in other causes of undetermined death Tyrer ism to the Holy City Witztum & Kalian, et aletal, 1999). But there is a limit to these 1999). In viewof our accumulated data, M. Kalian, E.Witztum PO Box 53199,Jerusalem benefits and some of those treated asser- Jerusalem should not be regarded as a 91531,Israel91531, Israel tively may be better cared for in hospital. pathogenic factor, since the morbid idea- Sashidharan et aletal find it hard to conceive tion of the affected travellers started else- that intensive case management might where. Jerusalem syndrome should be increase violence in community settings. regarded as an aggravation of a chronic Unfortunately, antisocial behaviour in all mental illness, and not a transient psychotic Effectiveness of intensive its forms has been shown to be more preva- episode. The eccentric conduct and bizarre treatment in severe mental illness lent in those with some personality disor- behaviour of these colourful yet mainly psy- The criticism of the PRiSM Psychosis Study ders in this type of service than in one in chotic visitors became dramatically overt MarshallMarshall et aletal, 1999; Sashidharan et aletal,, which hospital treatment is given more once they reached the Holy City ± a geo- 1999) betrays several misconceptions about readily Gandhi et aletal, 2000) and this could graphical locus containing the axis mundiaxismundi the nature and philosophy of community undermine progress towards better com- of their religious belief Turner, 1973). mental health teams in the UK. Unlike in munity care unless it is acknowledged as a We would also like to comment on another the USA, where assertive community treat- problem.problem. inaccurate interpretation, relating to ment ACT) teams were set up in a desert It is time for the programme of assertive Gogol's pilgrimage. It had nothing to do of community care, any similar teams in community treatment PACT) model of 492492 Downloaded from https://www.cambridge.org/core. 01 Oct 2021 at 02:01:22, subject to the Cambridge Core terms of use..
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