Biomedical subjects
Publications and source records attributed to A Apter.
Elective mutism (EM) is a rare psychiatric condition of childhood involving refusal to speak in social situations. We herewith describe such a case which developed into a full-blown schizophrenic illness. This may be the first detailed report of such an outcome in the literature.
The case is presented of a twelve-year-old boy suffering simultaneously from Tourette Syndrome (TS) and a manic episode. The problems of this unique clinical association are discussed from the point of view of differential diagnosis, treatment, and possible biochemical basis. The case also illustrates the usefulness of the expanded concept of TS as a neuropsychiatric disorder with dysregulation of perceptual, motor, and cognitive functioning.
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The treatment and clinical features of eight adolescents with obsessive compulsive disorder severe enough to warrant hospitalization are described. Attempts to use behaviour therapy failed, due to lack of co-operation from the patients. Nevertheless, response to non-specific psychotherapy and milieu therapy was surprisingly good. These observations are somewhat different from those reported in previous literature. The reasons for this difference are discussed.
High-affinity 3H-imipramine binding to platelet membranes was evaluated in 12 untreated children and adolescents aged 11-17 years who met the DSM-III criteria for major affective disorders. The affective patients were compared to 13 nonaffective subjects and 15 normal controls of similar ages. No significant difference in the maximal binding of 3H-imipramine (Bmax) and Kd values could be found among the three groups. 3H-Imipramine binding values failed to discriminate between patients with major depression and those with bipolar disorder, depressed type. No association between a positive family history of major affective disorders and 3H-imipramine binding values was detected.
Consecutive referrals numbering 177 to the psychiatrist in an Israeli general hospital emergency room (ER) over a two-month period were evaluated. Only one-third met our criteria of justifiability. When the general practitioner (GP) was the referral source, we considered only 29 per cent of cases justified as compared to 70 per cent of the self-referrals. A combination of poor understanding by the GP of when to refer urgently, efforts by the GP to bypass clinic waiting lists, and lack of alternative community facilities may have accounted for this finding.
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Low basal plasma testosterone levels with normal response to human chorionic gonadotropin (HCG) stimulation and mild hyperprolactinemia and blunted luteinizing hormone (LH) response to luteinizing-releasing hormone (LRH) stimulation were found in 10 adolescent schizophrenic boys who had been treated with chlorpromazine for more than 6 months. These findings may indicate a disturbance of the hypothalamic-pituitary-gonadal function in these patients, probably due to the prolonged administration of chlorpromazine. It remains to be established whether the decrease in basal testosterone secretion is caused directly by chlorpromazine or secondarily by the drug-induced hyperprolactinemia.
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This investigation was done in order to test the hypothesis that urinary MHPG levels provide a predictor of response to therapy in depressed patients. 15 elderly biopolar depressives were included in this study. Their depressive state was estimated by the Hamilton Depressive Scale and their urinary MHPG levels were simultaneously measured before and after 5 weeks of amitriptyline therapy. When comparing amitriptyline responders to nonresponders by parametric techniques, the responders excreted significantly higher mean MHPG levels before the treatment than the nonresponders. During treatment MHPG levels rose significantly in both groups.
1,148 women between the ages of 45 and 54 from five different ethnic groups in Israel, representing a traditional-modern continuum were investigated with regard to the relationship of their menopausal symptomatology with their work situations now and what they were when the women were aged 40. A relatively low symptomatology was found among European Jews, North African Jews and Arabs in the peri- or postmenopause where their work load was unchanged or somewhat more than before. On the other hand, the Persian Jews showed a remarkable contrast, namely: those who had never worked at all outside the home suffered less than all the others in all the stages of menopause. These results cannot be explained only by the socioeconomic differences between the five groups, as the North Africans and Persians both belong to the lower urban socioeconomic class and the Arabs to the low rural socioeconomic class, with the Europeans belonging to the middle urban class. Nor can the results be explained merely by the difference in modernity and traditionalism. The matter is more complicated, and additional factors such as physical health, marital relationships and general stability are almost certainly involved. The advice to "go out and work" which is so often given by medical practitioners to menopausal women is thus not always correct, and should not be given automatically.
Non-verbal behaviour has long been a focus of attention in the psychiatric literature. Furthermore, most psychiatric hospitals make use of non-verbal therapies in their milieu programmes. These include art, music and dance therapy, and related to the latter, movement therapy. This paper represents the beginning of an attempt to assess more scientifically the effectiveness of movement therapy. It describes the movement therapy programme on our adolescent unit, the evolution of a measuring scale and compares three groups of patients: (A) a group which had received individual therapy; (B) A group which had received group therapy; and (C) a control group. The results tend to confirm the effectiveness of movement therapy for psychotic adolescents.