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G Zalsman

Publications and source records attributed to G Zalsman.

14 recordsLinked to original sources
PubMed2001

Case control and family-based studies of tryptophan hydroxylase gene A218C polymorphism and suicidality in adolescents.

The association of suicidality with polymorphism A218C in intron 7 of tryptophan hydroxylase (TPH) gene remains controversial. The aim of this study was to use family-based methods to examine this association in adolescents in order to eliminate the difficulty of sampling a control group from the same ethnic population. Eighty-eight inpatient adolescents who recently attempted suicide were assessed by structured interview for detailed clinical history, diagnoses, suicide intent, suicide risk, impulsivity, aggression, and depression. DNA samples were collected from all subjects, from both biological parents of 40 subjects and from one parent of 9 subjects; TPH allele frequencies were calculated and tested for association to phenotype, stratified by severity, using the haplotype relative risk (HRR) and transmission disequilibrium test (TDT) methods (n = 49). The frequencies were also compared for all the Jewish subjects (n = 84) to the known frequencies of these alleles in healthy Jewish populations. There was no significant allelic association of A218C polymorphism with suicidal behavior or other phenotypic measures according to the HRR method (chi-square = 0.094; P = 0.76), the TDT (chi-square = 0.258; P = 0.61), or association analysis to known population frequencies (chi-square = 1.667, P = 0.19 for Ashkenazi, and chi-square = 0.810, P = 0.37 for non-Ashkenazi). Analysis of variance with the Scheffè test demonstrated a significant difference between CC and AA genotypes in suicide risk and depression among the patients (n = 88). The findings suggest that polymorphism A218C has no major relevance to the pathogenesis of adolescent suicidal behavior, but may have a subtle effect on some related phenotypes.

Adolescent↗
PubMed2001

Family-based association study of serotonin transporter promoter in suicidal adolescents: no association with suicidality but possible role in violence traits.

The serotonin transporter-linked promoter region polymorphism (5-HTTLPR) is thought to be associated with some serotonin dysfunction-related psychopathologies such as depression and anxiety disorders. Suicide and suicide-related behaviors such as violence, aggression, and impulsivity have been reproducibly associated with serotonin dysfunction and are partially genetic. This study examined the association of 5-HTTLPR with suicidal behavior and related traits in Israeli suicidal adolescent inpatients using the haplotype relative risk (HRR) method that controls for artifacts caused by population stratification. Forty-eight inpatient adolescents who recently attempted suicide were assessed by structured interviews for detailed clinical history, diagnoses, suicide intent, suicide risk, impulsivity, violence, and depression. Blood samples were collected and DNA extracted from patients and their biological parents. The 5-HTTLPR allele frequencies were tested for association with suicidality by the HRR method. In addition, the relationship between genotypes and phenotypic severity of several clinical parameters was analyzed. No significant allelic association of the 5-HTTLPR polymorphism with suicidal behavior was found (chi square = 0.023; P = 0.88). Analysis of variance of the suicide-related trait measures for the three genotypes demonstrated a significant difference in violence measures between patients carrying the LL and LS genotypes (9.50+/-4.04 vs. 5.36+/-4.03; P = 0.029). This study suggests that the 5-HTTLPR polymorphism is unlikely to have major relevance to the pathogenesis of suicidal behavior in adolescence but may contribute to violent behavior in this population.

Adolescent↗
PubMed2001

Stability of diagnosis: a 20-year retrospective cohort study of Israeli psychiatric adolescent inpatients.

Outcome according to diagnosis and stability of diagnosis were investigated in a follow-back study of 351 adolescents with various psychiatric disorders hospitalized in a closed psychiatric ward. The duration of follow-back was 15-19 years. All diagnoses were based on the ICD-9. Data were collected from the Health Ministry registry and, in the patients who could be located, by structured telephone interview. Special attention was directed at the diagnosis of transient adolescent psychosis (TAP) vs. schizophrenia and prognostic indicators of suicide. The results showed that the most stable diagnosis was anxiety disorder. The stability of the different diagnoses over time was greater between the second and last admission than between the first and last (for patients with three or more admissions). Number of hospitalizations correlated negatively with prognosis. TAP at second admission was an unstable diagnosis; 66% of these patients had a final diagnosis of schizophrenia. However, patients with a diagnosis of TAP at first admission had a higher predictive index score and a higher outcome score than schizophrenic patients. TAP appeared to be a valid diagnostic entity, distinguishable from schizophrenia in course, frequency of suicidal behaviour and social-occupational outcome. Suicide victims had a higher cumulative length of stay than age- and sex-matched non-suicidal patients. Fifty per cent of the suicide victims had a final diagnosis of schizophrenia, compared to 30 per cent for the whole sample. In conclusion, these findings indicate that TAP is associated with a relatively good prognosis and should probably be differentiated from schizophrenia. Further retrospective and prospective studies of adolescent psychiatric inpatients may help delineate the nature and course of psychosis and other psychopathology in this age group.

Adolescent↗
PubMed2001

Hypnotherapy in adolescents with trichotillomania: three cases.

Trichotillomania is not rare in adolescence. Psychotherapy is often ineffective, and cognitive behavioral therapy in combination with serotonin-specific reuptake inhibitors seems to be the treatment of choice. Some cases are resistant to all therapy. This paper reports on three adolescents with pure trichotillomania who responded to the imaginative hypnotherapy technique with Ericksonian suggestions. The patients described their hair as weak and vulnerable and needy of protection. In therapy, the patient was assigned the role of "patron of the hair" thereby giving him/her control of the situation. Hair pulling was significantly reduced, and the improvement was sustained throughout the 6-month follow-up. These cases suggest that imaginative techniques may be effective in adolescents with trichotillomania. Further controlled studies in adolescent population are needed to confirm this assumption.

Adolescent↗
PubMed2001

Heart rate variability in elderly patients before and after electroconvulsive therapy.

Earlier studies have found major depression to be associated with increased cardiac mortality, hypothesized to result from reduced vagal modulation. Since reduced heart rate variability is part of normal aging, depression might predispose elderly patients to a higher risk. The authors investigated cardiac autonomic modulation, using spectral analysis, in 11 elderly depressed inpatients before and after electroconvulsive therapy (ECT). Cardiac vagal modulation increased significantly after ECT and was associated with symptom improvement, assessed by a significant decrease in the Hamilton Rating Scale for Depression. Further research is needed to elucidate the relationship between depression, autonomic modulation, and clinical risks in elderly patients.

Aged↗
PubMed2000

Internalized anger, self-control, and mastery experience in inpatient anorexic adolescents.

OBJECTIVES: To evaluate the implications of internalized anger, self-control and experience of mastery for adolescent girls with severe anorexia nervosa (AN). METHODS: Internalized and externalized anger, internal and external control, mastery, use of methods for self-control, and severity of anorexic symptoms were measured by self-report questionnaires in inpatient anorexic teenagers (N=26), inpatient female adolescent psychiatric patients (N=24), and a normal female comparison group (N=29). RESULTS: Internalized anger was significantly higher in both the anorexic and general psychiatric patients as compared to normal controls, but this difference was significant only for the anorexic patients. Anorexic and general psychiatric patients experienced significantly less mastery than normal controls, but again this difference was significant only in the anorexic group. Within the anorexic group, severity of symptoms correlated significantly with internalized anger, low mastery, and external locus of control, and negative significant correlations among control measures and anger were found. Total length of hospitalization correlated positively with internalized anger only for the anorexics. CONCLUSION: The findings support the notion that internalized anger and defective experience of self-control are important factors in the psychopathology of adolescent anorexic inpatient females The results may have implications for the clinical management of patients with severe AN.

Adolescent↗
PubMed2000

Human figure drawings in the evaluation of severe adolescent suicidal behavior.

OBJECTIVE: To evaluate the reliability of using certain indicators derived from human figure drawings to distinguish between suicidal and nonsuicidal adolescents. METHOD: Ninety consecutive admissions to an adolescent inpatient unit were assessed. Thirty-nine patients were admitted because of suicidal behavior and 51 for other reasons. All subjects were given the Human Figure Drawing (HFD) test. HFD was evaluated according to the method of Pfeffer and Richman, and the degree of suicidal behavior was rated by the Child Suicide Potential Scale. RESULTS: The internal reliability was satisfactory. HFD indicators correlated significantly with quantitative measures of suicidal behavior; of these indicators specifically, overall impression of the evaluator enabled the prediction of suicidal behavior and the distinction between suicidal and nonsuicidal inpatients (p < .001). A group of graphic indicators derived from a discriminant analysis formed a function, which was able to identify 84.6% of the suicidal and 76.6% of the nonsuicidal adolescents correctly. Many of the items had a regressive quality. CONCLUSIONS: The HFD is an example of a simple projective test that may have empirical reliability. It may be useful for the assessment of severe suicidal behavior in adolescents.

Adolescent↗
PubMed1998

Multiplex developmental disorder.

BACKGROUND: Multiplex developmental disorder is a term that was suggested 20 years ago to describe the onset of developmental deficits in affective modulation, social behavior and social sensitivity combined with thinking disorder with bizarre ideas. With the recent validation of these diagnostic criteria, new interest in this disorder has emerged. METHODS AND RESULTS: We reviewed the background and the difficulties in classifying this subgroup of patients. We also describe a representative case of multiplex developmental disorder and discuss the diagnosis. CONCLUSION: This article emphasizes the importance of investigating this subgroup of patients and encourages reports of such cases in Israel.

Child↗
PubMedDate not supplied

Psychosocial diagnosis in psychiatrically hospitalized adolescents.

This study examines the relevance of a psychosocial diagnostic system developed by the World Health Organization (WHO; International Classification of Diseases [ICD] 10 axis V) for psychiatrically hospitalized inpatient adolescents and assesses the reliability of semistructured interviews for making these psychosocial diagnoses. Seventy-one consecutive patients admitted to an adolescent unit and their parents were interviewed. The semistructured interviews were derived from the criteria for each psychosocial (axis V) diagnosis. Inter-rater and test-retest reliability were measured for both child and parent interviews on a subsample of 57 and 25 subjects, respectively. Results showed high inter-rater reliability (kappa = 0.8 to 1.0). Some test-retest reliabilities were high and others were low (kappa = 0.4 to 1.0). Parent-child agreement was erratic (kappa = 0.2 to 0.7). All of the psychosocial diagnostic entities were common and relevant to our patient population. We conclude that it is possible to make reliable and relevant psychosocial diagnoses in severely ill adolescents.

Adolescent↗
PubMedDate not supplied

Hair loss associated with paroxetine treatment: a case report.

Alopecia and hair loss are rare side effects of psychotropic drugs. There are a few case reports on hair loss associated with tricyclic antidepressants and serotonin selective reuptake inhibitors (SSRIs), but none deal specifically with paroxetine. We report on a 37-year-old female who complained of moderate hair loss during paroxetine treatment. Findings on discontinuation and rechallenge supported the assumption that the hair loss was a side effect of the paroxetine. Further investigation is needed to determine the scope of this troubling side effect.

Adult↗
PubMedDate not supplied

Alprazolam withdrawal delirium: a case report.

Benzodiazepine withdrawal delirium is thought to be uncommon. Only two clear reports of alprazolam withdrawal appear in the literature, but the use of this drug is expected to increase because of its recent approval for the treatment of panic disorder. We report on a patient with severe alprazolam withdrawal delirium that developed immediately after an accidental reduction of the dose. This case demonstrates importance of clinician awareness of the previous use of alprazolam in individual patients, especially in hospital settings where free patient use of drugs is prohibited.

Aged↗