The new Israeli psychiatric legislation for the minor (1995) and its relationship to the 1991 Law for the Treatment of the Mentally Ill.
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Adolescent↗
Biomedical subjects
R Mester
Publications and source records attributed to R Mester.
Psychiatric and polysomnographic evaluation of sleep disturbances.
BACKGROUND: We evaluated psychiatrically 100 subjects, who were referred to a sleep laboratory in a general hospital because of sleep complaints. METHODS: All subjects were interviewed using a Structured Clinical Interview for DSM-III-R and underwent one night of standard polysomnography (PSG) examination. RESULTS: Forty three percent of the population had at least one Axis I DSM-III-R disorder. High rate of depressive mood disorder (24%) was observed in our sample, in contrast to low prevalence of alcohol and drug abuse (4%). Our results of a Israeli population are different from the United States studies in respect to alcohol and drug abuse. Furthermore, 11% of patients with PSG diagnosis exhibited comorbid psychiatric disorder. CONCLUSION: it appears that individuals with sleep complaints have high rate of psychiatric morbidity, especially mood disorders. LIMITATION: The rapid eye movement (REM) latency, a biological marker for depression, was not investigated. CLINICAL RELEVANCE: it seems that both PSG and psychiatric evaluation of sleep disturbance are of importance for appropriate therapeutic strategy for individuals with sleep complaints, especially in those with features of suspected depressive mood disorders.
Adult↗
Lateral preference in post-traumatic stress disorder.
BACKGROUND: We assessed lateral preference in 80 male patients with combat-related post-traumatic stress disorder (PTSD) and in 100 healthy age-matched male controls. METHODS: Hand, foot, eye and ear preferences were examined, using the Edinburgh Handedness Inventory-Modified and the Coren Inventory of Lateral Preference. RESULTS: Mixed lateral preference was noted in significantly more PTSD patients than controls (65 v. 43%, P < 0.005). CONCLUSIONS: These results indicate a possible hemispheric imbalance (less lateralization) in PTSD patients, with the right hemisphere playing a more active role in perceptual and cognitive processing and in the regulation of biological responses in these patients. This imbalance may be relevant to the pathophysiology of PTSD.
Adult↗
Elevated serum creatine kinase activity in adolescent psychiatric inpatients on admission.
Studies in adults have indicated a significant relationship between high serum creatine kinase levels on admission and acute psychosis. However, data on children are sparse. The files of 183 hospitalized children and adolescents (93 boys, 90 girls) with severe psychiatric disorders were reviewed for serum creatine kinase activity on admission, psychomotor agitation, Clinical Global Impression Score, need for intramuscular injection, number of neuroleptic medications and presence of neuroleptic malignant syndrome. Serum creatine kinase levels > 201 IU/ml were considered abnormal. Boys had significantly higher creatine kinase activity than girls. Division of the cohort by diagnosis yielded significantly higher levels in those with schizophrenia, affective disorders and mental retardation. Higher levels were also associated with higher Clinical Global Impression score on admission, use of injections and physical restraint, and nonresponse to neuroleptic medication. There were no cases of neuroleptic malignant syndrome. This first large-scale investigation of serum creatine kinase activity in young psychiatric inpatients shows a significant association between high creatine kinase activity and acute psychosis, similar to that in adults. Furthermore, high creatine kinase levels on admission are predictive of the severity of the psychosis, but are not associated with neuroleptic malignant syndrome. Because psychotic adolescents with high admission creatine kinase levels tend to be nonresponders, clinicians should consider the early use of atypical antipsychotics in this subgroup.
Adolescent↗
Belief in transmigration of the soul and psychopathology in Israeli Druze. A culture-sensitive psychotherapeutic approach.
One of the central tenets of the Druze religion is the transmigration of the soul. In rare cases this belief may be related to psychopathology or cause a temporary inability to function normally. We report on 5 Druze patients whose preoccupation with transmigration was the basis of their pathological behavior. These cases illustrate the interaction between cultural and religious beliefs, and psychopathology, and emphasize the importance of employing a culture-specific psychiatric approach in the management of this type of patients.
Adult↗
Pathological laughter: common vs. unusual aetiology and presentation.
Pathological laughter and crying is a well known clinical phenomenon which in most cases appears in association with diverse neurological and psychiatric symptoms and signs. It is not a disturbance of affectivity but rather of the motor concomitant of affective expression. Its main clinical characteristics are: absence of voluntary control and absence of the corresponding change in mood. It is not accompanied by the emotional lability of the organic brain syndromes, it does not present the inappropriate jocularity of the patients with frontal lobe disturbance, it is not due to the intoxicating effect of alcohol or addictive drugs and there are no typical symptoms of manic syndromes (such as grandiose self-esteem, flight of ideas, hyperactivity, etc.). In this paper three cases of pathological laughter are presented, two of these associated with organic brain conditions. The discussion will deal in particular with aetiological considerations and psychopathology of the third case which was unusual because it was a monosymptomatic condition and seemed to be the expression of a posttraumatic stress disorder.
Adult↗
Elevated levels of serum interleukin-1 beta in combat-related posttraumatic stress disorder.
Levels of serum interleukin-1 beta (IL-1 beta) and soluble interleukin-2 receptor (sIL-2R) were assessed in 19 male patients with combat-related posttraumatic stress disorder (PTSD) in comparison to 19 age- and sex-matched healthy volunteers. Serum IL-1 beta levels (but not sIL-2R) were significantly higher (p < .001) in the PTSD patients than in the controls. IL-1 beta levels did not correlate with cortisol levels, severity of PTSD, anxiety, depressive symptoms, or alexithymia score; however, they did correlate significantly (r = .54, p < .005) with the duration of PTSD symptoms. It is possible that desensitization of the hypothalamic-pituitary-adrenal axis in chronic PTSD patients counteracts the stimulatory effect of IL-1 beta on cortisol secretion.
Adult↗
Reduction of aggressiveness and impulsiveness during clozapine treatment in chronic neuroleptic-resistant schizophrenic patients.
Aggressive and impulsive behavior is frequently observed in schizophrenic patients. Previous studies suggest that impulsive aggression may be the most common behavioral correlate of central serotonergic system dysfunction. This study was aimed to determine if clozapine, an atypical antipsychotic agent with potent serotonergic antagonistic properties, can reduce impulsiveness and aggression in neuroleptic-resistant chronic schizophrenic patients. Fourteen neuroleptic-resistant chronic schizophrenic patients were treated with clozapine and prospectively evaluated for aggressiveness and impulsiveness for 18 weeks. Clozapine treatment induced a marked decrease in impulsiveness (32% on the Impulsivity Scale; p < 0.0001) and aggressiveness (98% on the Overt Aggression Scale; p < 0.0001). We conclude that clozapine treatment may be effective in reducing psychotic symptoms as well as in controlling aggressive and impulsive behavior in neuroleptic-resistant chronic schizophrenic patients.
Adult↗
Trihexyphenidyl treatment of clozapine-induced hypersalivation.
The objective of this study was to investigate the efficacy of the anticholinergic agent trihexyphenidyl in the treatment of clozapine-induced hypersalivation. Fourteen chronic schizophrenic patients who exhibited nocturnal hypersalivation during clozapine treatment were coadministered trihexyphenidyl (5-15 mg/day, at bedtime) for 15 days. Salivation was assessed by a single-item 5-point scale. A reduction of 44% in the reported nocturnal hypersalivation was observed after trihexyphenidyl treatment. These results indicate that at least some chronic schizophrenic patients with clozapine-induced nocturnal hypersalivation may benefit from anticholinergic treatment.
Adult↗
An open trial of clozapine in neuroleptic-resistant childhood-onset schizophrenia.
BACKGROUND: Studies performed with schizophrenic adults who were resistant to classical neuroleptics showed improvement in 30% of the patients when treated with clozapine. Very early onset schizophrenic patients benefit only partially from conventional antipsychotics and are at increased risk of developing extrapyramidal symptoms; clozapine may offer an alternative treatment for these patients. METHODS: Eleven neuroleptic-resistant children (< 13 years) with schizophrenia were treated with clozapine. Improvement was monitored during the first 16 weeks using the Brief Psychiatric Rating Scale, Positive and Negative Syndrome Scale and Clinical Global Impression. The mean clozapine dosage was 227.3 (s.d. 34.4 mg/day at the end of the 16 weeks. RESULTS: There was an overall statistically significant reduction in all parameters, especially positive symptoms, implying a favourable outcome. Most of the improvement occurred during the first 6 to 8 weeks. The major side-effects were somnolence and drooling (no agranulocytosis). CONCLUSION: Clozapine may be a promising drug for the treatment of resistant childhood-onset schizophrenia.
Adolescent↗
Clozapine treatment for neuroleptic-induced tardive dyskinesia, parkinsonism, and chronic akathisia in schizophrenic patients.
BACKGROUND: Previous studies on the use of clozapine in neuroleptic-resistant chronic schizophrenic patients have demonstrated positive effects on tardive dyskinesia but were less conclusive about chronic akathisia and parkinsonism. The aim of the present study was to investigate the short-term (18 weeks) efficacy of clozapine in neuroleptic-resistant chronic schizophrenic patients with coexisting tardive dyskinesia, chronic akathisia, and parkinsonism. METHOD: Twenty chronic, neuroleptic-resistant schizophrenic patients with coexisting tardive dyskinesia, parkinsonism, and chronic akathisia were treated with clozapine. Assessment of tardive dyskinesia, parkinsonism, and chronic akathisia was made once weekly for 18 weeks with the Abnormal Involuntary Movement Scale (AIMS), Simpson-Angus Rating Scale for Extrapyramidal Side Effects, and Barnes Rating Scale for Drug-Induced Akathisia (BAS). RESULTS: At the end of 18 weeks of clozapine treatment, improvement rates were 74% for tardive dyskinesia, 69% for parkinsonism, and 78% for chronic akathisia. A statistically significant reduction in the scores on the AIMS and Simpson-Angus Scale was achieved at Week 5 and on the BAS at Week 6 (p < .0001). CONCLUSION: Relatively low doses of clozapine are effective for the treatment of neuroleptic-induced extrapyramidal syndromes in neuroleptic-resistant chronic schizophrenic patients. The relief of tardive dyskinesia, parkinsonism, and chronic akathisia in this group of patients occurs more rapidly than the reduction in psychotic symptoms. Disturbing, long-term extrapyramidal syndromes in chronic schizophrenic patients should be considered an indication for clozapine treatment.
Adult↗
Involuntary hospitalization of delirium patients in Israel: a psychiatric case register study.
This paper compares the national Psychiatric Case Register (PCR) data of two groups of delirium patients who were admitted to psychiatric hospitals. One group consists of patients who underwent involuntary civil commitment following a hospitalization order by a district psychiatrist. The second group consists of delirium patients who were voluntarily admitted. During the period 1984-1993, 805 patients with a diagnosis of delirium were admitted to psychiatric hospitals: 710 (88%) were admitted on a voluntary basis, 88 (10.9% were admitted through civil commitment, 7 (0.8%) were admitted in other ways. The two major groups are further analysed regarding demographic, clinical and administrative variables. No statistically significant differences were found between the groups concerning the clinical and administrative variables studied (type of admission, suicide attempt prior to admission, length of hospitalization, type of discharge). Given the prevailing tendency to treat delirium patients in general hospitals, the small number of those involuntarily admitted and the lack of clinical and administrative differences between the groups, the appropriateness of civil commitment procedures regarding delirium patients is questioned.
Adolescent↗
Psychopathology in dementia.
The purpose of this overview is to describe the psychological and behavioral symptoms of dementia reported in the professional literature in recent years. This subject, a relatively neglected one, is considered in order to focus attention on a number of the symptoms most troublesome to the demented person's surroundings which lead to his/her hospitalization, with all the implications this has on the patients, their families and the community's health budget. To carry out an early and effective intervention, professionals need to define and recognize these symptoms and gain experience in treating them, either by intervention in the environment or by medication. This survey attempts to examine the state of the art in this field, while analyzing the difficulties that emerge in studying it.
Alzheimer Disease↗
Depression in women treated with a gonadotropin-releasing hormone agonist.
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Adult↗
[Psychiatric aspects of menopause].
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Depression↗
Chronic GnRH agonist administration down-regulates platelet serotonin transporter in women undergoing assisted reproductive treatment.
The effect of pretreatment with the gonadotropin releasing hormone (GnRH) agonist D-Trp6-LHRH (Decapeptyl) on platelet serotonin transporter in women undergoing assisted reproductive treatment (ART) was investigated and compared with women treated with human menopausal gonadotropin (Pergonal). The study group (n = 10) was exposed for 12 days to 3.2 mg Decapeptyl C.R. while a comparison group (n = 9) was exposed to 11 days of human meno-pausal gonadotropin (Pergonal). All patients were assessed with the Hamilton depression and anxiety scales before and after treatment, and platelet and plasma samples were collected at the same time points. Plasma levels of estradiol, progesterone. FSH and LH were determined by radioimmunoassay (RIA). Platelet serotonin transporter was labeled using high affinity [3H]imipramine binding. The GnRH analogue induced ovarian suppression as reflected by low plasma estradiol levels, while Pergonal administration induced ovarian stimulation. An elevation in the Hamilton depression and anxiety scale scores was observed in the Decapeptyl treated group; this mood alteration was associated with a significant decrease (19%, P < 0.05) in the density (Bmax) of platelet [3H]imipramine binding sites. No significant change was observed in the Bmax of the Pergonal treated group. These results indicate that ovarian suppression (menopausal-like state) in young women is associated with depressed and anxious mood and decreased serotonin transporter density.
Adult↗
Neuroleptic malignant syndrome associated with abrupt withdrawal of anticholinergic agents.
Neuroleptic malignant syndrome (NMS) is a severe side-effect of neuroleptic treatment. It is usually related to hypodopaminergic activity. A young schizophrenic patient who developed a typical episode of NMS during abrupt withdrawal of long-acting neuroleptic combined with anticholinergic treatment is described. NMS appeared following combined neuroleptic/ anticholinergic withdrawal and responded to procyclidine administration. The appearance of NMS after discontinuation of antidopaminergic treatment seems to be in conflict with the hypodopaminergic theory of this adverse effect. It is suggested that simultaneous withdrawal of both anticholinergic and neuroleptic medications, mainly long-acting neuroleptics, seems to be a risk factor for NMS.
Adult↗
Further insights into transsexualism.
Transsexualism is a challenging entity posing diagnostical, etiological, ethical and moral questions with no general consensus of opinion and a controversial management policy. The present article tries to deal with these questions by drawing a parallel with another psychiatric syndrome in which there is also a disturbance in body image, namely anorexia nervosa. The parallel is at the level of clinical presentation, psychodynamic etiology and their common socioepidemic dimension.
Anorexia Nervosa↗