Biomedical subjects
Publications and source records attributed to A Bleich.
This paper reviews the literature concerning the use and theoretical background of paradoxical maneuvers in conventional psychotherapy. By demonstrating a clinical example we highlight the usefulness of such an approach and the necessity for further research in finding valid indications and contraindications for its use.
Memory-related effects of electroconvulsive therapy (ECT) are known to appear immediately after the treatment. The case of a 39-year-old woman who underwent a course of ECT because of a recurrent major depressive disorder is described. After a symptom-free period of 48 hours, transient amnesia developed. Her condition appeared to be associated with the electroconvulsive therapy, thereby raising questions about its pathogenicity and management.
It is assumed that the incidence of anorexia nervosa and bulimia nervosa in the general population has been increasing. Medical personnel in the IDF also believe this to be true with regard to their female soldiers. We administered the eating attitude test (EAT) to 1112 female soldiers at the beginning of their military service and determined weight and height for each. Those whose EAT scores were high or whose weights were low were then interviewed by the study psychiatrist and the author. 2 of them (0.2%) were found to be suffering from anorexia nervosa. Both were identified by their low weights; their EAT scores were both normal. 27 (2.4%) were diagnosed as having a partial eating disorder syndrome, in a third of whom it was severe. The severe cases were also identified by their weights and not by EAT scores. In addition, 4 (0.5%) had bulimia nervosa, all of whom were identified from their EAT scores. These findings are similar to those of some of the most recent studies in the field. The deficiencies of the EAT scale were more apparent in this than in other studies. Because of its relatively low PPV as well as the apparent reluctance of many subjects to answer truthfully, the scale is not effective by itself for screening purposes. As was shown in this study, measuring weight and height in addition considerably improved accuracy of screening.
During the Gulf War, the Unit for the Treatment of Combat Reactions within the Central Military Mental Health Center of the IDF was active in treating soldiers suffering from post-traumatic stress disorder (PTSD). Of the 72 referrals, all but 2 were cases of a reactivation of a previous stress reaction. The implications for residual vulnerability amongst even apparently remitted cases are discussed in this essay.
The experience of the Central Military Mental Health Clinic during the Gulf War is summarized here. Many of the difficulties confronted by soldiers, as well as the treatment offered at the Clinic, are described. Possible explanations for the absence of a significant rise in wartime referrals to the Clinic are also suggested.
Awakening thresholds from sleep stage 3/4 were investigated in 19 DSM-III-defined, war-related post-traumatic stress disorder (PTSD) patients compared with 6 normal controls. Patients had significantly higher awakening thresholds and significantly longer latencies to an arousal response than controls. These results are interpreted to suggest modifications in the depth of sleep as one of the long-term sequelae of traumatic events.
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An attempt to evaluate parachute-drop related stress by determining the blood lipid profile (cholesterol, LDL, HDL, apo-A, apo-B, and triglycerides) is reported. Measurements were made on starting the parachute course, just before the first jump, and just after the third jump. On these 3 occasions 38 combat troops answered psychological questionnaires and 30 of them gave blood samples. While there were significant fluctuations in level of all blood lipids and their apoproteins, they could not be correlated selectively with presumed levels of stress. The well-known difficulties in field studies in controlling crucial factors such as the exact timing of the measurements and food intake (specific diet or fasting) make questionable the use of biochemical markers in measuring stress under the conditions of our study. It is possible that the high rate of refusal to give blood samples biased the findings.
There is considerable controversy over whether or not post-traumatic stress disorder (PTSD) should be considered as a separate diagnostic entity. The present study utilized the Symptom Checklist-90 (SCL-90) in order to examine the degree of overlap between PTSD and the related diagnoses of anxiety, depression and obsession-compulsion in a group of Israeli Lebanon War PTSD casualties. We found that the SCL-90 was able both to identify and discriminate between the clinical groups. Multiple discriminant analysis showed that although there is overlap between PTSD and obsessive-compulsive disorder, PTSD is, in fact, discriminated from all the other patient groups.
One of the newer scales of suicide risk devised by Plutchik and colleagues was tested to see if it could discriminate between levels of suicide ideation and suicide attempts. A sample of 80 subjects were placed into various categories of suicide risk on the basis of a psychiatric examination. Results showed that the full scale did not adequately discriminate among groups. An explantation of the results has been proposed and a design to test this suggestion described.
[3H]PK 11195 binding to platelet membranes and plasma stress hormones were studied in soldiers at the beginning of a parachute training course, following 6 days of preparatory exercises, and after the fourth actual parachute jump. A slight reduction (15%; NS) in the number of peripheral benzodiazepine receptors (PBR) was detected at the end of the exercise period, prior to the first jump. Reduced (26%; P less than 0.05) density of PBR was observed immediately after the repeated actual jumps. Equilibrium dissociation constants were not affected by the stressful situation. Plasma cortisol and prolactin levels remained unaltered during the entire study period.
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In this study, the amount of psychological distress reported by soldiers is investigated and measured over time. The soldiers--enlisted and career--were randomly chosen while visiting five different military primary care clinics (for ostensible somatic problems) and administered the General Health Questionnaire (Goldberg and Huxley, 1980). A third of the subjects were given the GHQ a year later. Fifty-two percent showed psychological stress: combat soldiers showed considerably less distress than technical/maintenance and administrative soldiers, and the psychological stress findings remained relatively stable over time. Possible explanations for these findings are discussed.
Adenylate cyclase and phospholipase C activity were examined in platelet membranes obtained from 19 male subjects with combat-related posttraumatic stress disorder (PTSD) and 35 age- and gender-matched healthy controls. Basal and forskolin-stimulated adenylate cyclase activity were significantly lower in the PTSD group whereas aluminum chloride plus sodium fluoride (AlCl3/NaF)- and prostaglandin E1 (PGE1)-stimulated responses were normal. There was no difference in phospholipase C activity between the two groups. The lower basal and forskolin-stimulated adenylate cyclase responses replicate a previous report and suggest that PTSD may be associated with an abnormality of the catalytic subunit of the receptor-adenylate cyclase complex.
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In search of a physiological marker of depression and suicidal behavior, serotonin receptors of the 5-HT2 type were studied on platelet membranes from 19 control and 22 suicidal subjects. All were young, drug- and medication free men (18-21-years-old). 5-HT2 receptor binding was assayed using tritiated ketanserin at two concentrations. Receptor binding in the suicidal subjects was significantly higher than controls at both concentrations, the mean difference being around 50%. A similar difference between patients with major depressive disorder and matched controls has been observed previously. These findings support the use of 5-HT2 receptors on platelets as a research and diagnostic tool in depression and suicide.
To explore psychological and somatic distress following trauma, the authors compared 50 combat veterans with chronic posttraumatic stress disorder (PTSD) with 48 age-matched combat veterans without PTSD. Both groups were evaluated on symptom reports, physical examination findings, and laboratory tests. Subjects with PTSD reported significantly more symptoms, but they did not differ from controls on their physical examination and laboratory test findings. Adverse health practices (smoking, alcohol use, and deregulation of food intake) were significantly more frequent in the PTSD group. Low effort tolerance, as has been reported in panic disorder patients, was observed in the PTSD group.
A modern complaint--fear of AIDS--is making its way into the world of psychopathology and is becoming a symptom of a wide range of psychiatric disorders, including severe ones. We present a case of a young man who developed a pathological bizarre preoccupation of having AIDS and underwent various unnecessary medical procedures, until finally he was diagnosed as suffering from a paranoid schizophrenic disorder. With the high media profile that AIDS has achieved in recent years, it is expected that AIDS has become the object of psychopathological processes. However, the length of time elapsed between the onset of symptoms and the appropriate psychiatric diagnosis, despite being examined by other medical professionals, is surprising. The discussion focuses on the diagnostic questions and on issues related to primary and secondary psychiatric prevention.