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Biomedical subjects

Roberto Mester

Publications and source records attributed to Roberto Mester.

At least 19 recordsLinked to original sources
PubMed2006

Trends in involuntary psychiatric hospitalization in Israel 1991-2000.

BACKGROUND: Though information about involuntary psychiatric hospitalizations (IPH) is crucial for the planning of Israel's National Mental Health Care Policy, very few studies have been carried out to date on this subject. AIMS: To identify trends in first IPH to all inpatient psychiatric settings in Israel. METHOD: The sample included all admissions of adults (18 years and older) over the ten-year period, 1991-2000, according to the registration of such admissions in the National Psychiatric Case Registry. RESULTS: A 2.4-fold increase was found in first IPH over the decade studied. The typical profile of the involuntarily admitted patient was that of a native-born Jewish male, aged 18-24 or 65 and older, single, with less than 8 years of education, and with a diagnosis of schizophrenia or delusional psychosis. CONCLUSIONS: These findings suggest the need for improving the interfaces between hospital and community services, and for preparing specific guidelines to extend the use of involuntary ambulatory treatment orders. Further study is needed to explore the respective roles of involuntary inpatient and outpatient treatment.

Adolescent↗
PubMed2006

Comparison between risperidone, olanzapine, and clozapine in the management of chronic schizophrenia: a naturalistic prospective 12-week observational study.

Risperidone, olanzapine, and clozapine are three atypical antipsychotic medications commonly used in the management of chronic schizophrenia. While they offer advantages with regard to clinical efficacy and side-effect profile, few studies have compared them in a naturalistic prospective observational manner. This study therefore investigated their comparative efficacy over 12 weeks including illness characteristics and adverse effects. One hundred thirty-one patients (76 M, 55 F) with DSMI-V schizophrenia or schizoaffective disorder were treated with risperidone (n = 38), olanzapine (n = 38), or clozapine (n = 55). All patients showed a significant decrease of Positive and Negative Syndrome Scale (PANSS)-positive scores. Decreases in tardive dyskinesia and impulsivity scores were noted with clozapine and olanzapine, respectively. No differences between the medications were noted on depression, anxiety, EPS, or overt aggression scores. Olanzapine and clozapine appeared to be more effective in females. Males showed a decreased sexual performance irrespective of the medication and those treated with risperidone and clozapine showed greater proportional reduction of overt aggression. Clozapine-treated patients showed significant increased weight, increased glucose levels, and lowered sexual performance. Risperidone patients tended to exhibit reduced cholesterol levels. Higher creatine kinase (CK) levels were noted in risperidone-treated patients. While cautious given the nature of the study design, results suggest differences in the response to various atypical antipsychotic medications regarding efficacy and side-effect susceptibility.

Adolescent↗
PubMed2006

Stalking.

Stalking is a frequently reported crime. It has a strong impact on the lives and mental health of the victims. It is perpetrated by persons who often suffer from mental disorders. This paper is an overview on the subject. It encompasses the various definitions of stalking, a number of classifications or sub-divisions of the phenomenon according to different approaches, a description of the psychopathology of the stalker, the psychological effect of the stalking on the victim, ways of evaluating and managing the phenomenon both in the victims and in the perpetrators, prevention of stalking, and also relevant bibliography. In addition, the paper includes an Appendix containing case series (clinical vignettes which include diagnosis, medical and legal interventions and outcome).

Compulsive Behavior↗
PubMed2006

Simple real-time computerized tasks for detection of malingering among murderers with schizophrenia.

It is our contention that computer-based two-alternative forced choice techniques can be useful tools for the detection of patients with schizophrenia who feign acute psychotic symptoms and cognitive impairment as opposed to patients with schizophrenia with a true active psychosis. In our experiment, Visual Simple and Choice Reaction Time tasks were used. Reaction time in milliseconds was recorded and accuracy rate was obtained for all subjects' responses. Both types of task were administered to 27 patients with schizophrenia suspected of having committed murder. Patients with schizophrenia who were clinically assessed as malingerers achieved significantly fewer correct results, were significantly slower and less consistent in their reaction time. Congruence of performance between the Simple and Choice tasks was an additional parameter for the accurate diagnosis of malingering. The four parameters of both tests (accuracy of response, reaction time, standard deviation of reaction time and task congruency) are simple and constitute a user-friendly means for the detection of malingering in forensic practice. Another advantage of this procedure is that the software automatically measures and evaluates all the parameters.

Adult↗
PubMed2006

Rehospitalizations among psychiatric patients whose first admission was involuntary: a 10-year follow-up.

OBJECTIVES: To examine the characteristics of patients whose first admission to Israel's psychiatric units was involuntary, and to identify a specific profile of the patients at increased risk for future readmissions. Our hypothesis was that when the first admission of a patient was involuntary, the number and duration of future hospitalizations would be greater. METHOD: We used information extracted from the National Psychiatric Case Registry on all patients admitted for the first time during 1991 (N=2150) and on their follow-up over the next ten years. Chi-square statistics were used to test for significance differences in demographic and clinic variables between patients hospitalized voluntarily and those hospitalized involuntarily. Multiple regression analysis was performed to identify a specific profile of risk of recidivism during a ten-year period (1991-2000). RESULTS: Compared with patients admitted voluntarily, those who were admitted involuntarily had a significantly greater number and duration of rehospitalizations. They were more likely be diagnosed as suffering from schizophrenia while the voluntarily admitted patients were more likely be diagnosed as having an affective disorder. Risk factors for the number of readmissions included: young age, legal status (involuntary) of the first admission, as well as period of residence in the country. Risk factors affecting the duration of readmissions were single/widowed status, native born and a suicide attempt in the two months prior to the first admission. CONCLUSIONS: Two distinct profiles for the number ofreadmissions and inpatient days were identified. A diagnosis of schizophrenia and selected demographic variables were better at predicting risk of recidivism than the involuntary legal status of the first admission.

Adult↗
PubMed2005

Regional psychiatric boards in Israel: expectations and realities.

As laid down by Israeli legislation, the Regional Psychiatric Board constitutes one of the chief instruments in the monitoring of compulsory hospitalization, of compulsory outpatient treatment and of the quality of all inpatient care of the mentally ill. This article presents the findings of a study into the working of these boards. Taking a sample of every second application (N=168) over a 6-month period to one of Israel's six existing Regional Psychiatric Boards, an examination was made of the decisions issued by the board and of other aspects of its functioning. Explanations for the findings of this analysis are suggested, and generalizing from these findings, recommendations are offered for the improvement of the future functioning of all six Boards.

Advisory Committees↗
PubMed2004

Comparing aspects of mental health legislation of Israel and Massachusetts.

This paper compares the manner in which two sets of mental health laws, that of Massachusetts, U.S.A., and that of the State of Israel, deal with specific areas of civil enforced commitment. The definition of psychiatric disorder that justifies commitment is broader in Massachusetts, in Israel psychosis alone is considered, excluding conditions such as severe non-psychotic depression, obsessive-compulsive disorder and anorexia. In Israel, commitment is possible only when there is a risk of danger that is immediate. In Massachusetts, only a judge can make decisions beyond the first four days, while in Israel they are made by a District Psychiatrist. Unlike Massachusetts, there is no possibility of enforced commitment of alcoholics or drug addicts in Israel, even in the presence of impaired judgement and severe family distress. The changing trends are presented, as Israel seems to be drawing slowly toward the Massachusetts position in some of these issues. The role of consumers in these processes is considered, as is the possibility of enforced commitment of people with severe personality disorders.

Commitment of Persons with Psychiatric Disorders↗
PubMed2003

The platelet-poor plasma 5-HT response to carbohydrate rich meal administration in adult autistic patients compared with normal controls.

There are cumulative data indicating involvement of the 5-HT system in autistic disorder. Most studies examining 5-HT function have focused on whole blood 5-HT content. The carbohydrate-rich meal test (CRMT) is a dietary manipulation that could significantly influence platelet-poor plasma (PPP) 5-HT levels and reflect the responsiveness of the serotonergic system in 'free' plasma. In this study, CRMT was used as an indicator of 5-HT responsivity in drug-free adults with autistic disorder (n = 7), compared with normal controls (n = 10). The PPP 5-HT levels were measured at baseline and during 3 h after administration of the CRMT. A significant elevation in PPP 5-HT levels in adult autistic patients was reached 60 min after meal administration (p < 0.03 vs control and p = 0.05 vs baseline) and a significant decrease was noted after 120 min (p < 0.01 vs baseline). In contrast to the biphasic response of the autistic patients, normal controls exhibited a gradual linear increase of PPP 5-HT levels. Our results indicate that in adult autistic patients, the pattern of PPP 5-HT responsivity to a dietary challenge of CRMT is dysregulated compared with normal controls and provide further support for the role of 5-HT in autism.

Adult↗
PubMed2003

The significance of the nitric oxide in electro-convulsive therapy: a proposed neurophysiological mechanism.

Electroconvulsive therapy (ECT) is used to treat patients with major depressive disorder, manic episodes and other serious mental disorders. Virtually every neurotransmitter system is affected in ECT. The significance of the nitric oxide (NO), which has an established role as a neurotransmitter, neuromodulator, and an intraneuronal second messenger, in ECT is still not clear. We described the involvement of NO in long-term potentiation, the N-methyl-D-aspartic acid (NMDA) receptor activity, regulation of cerebral blood flow, and the hypothalamic-pituitary axis and propose that this involvement is critical in ECT's efficiency, treatment refractoriness, and neuropsychological sequelae by its influences on these systems. Nitric oxide's significant role in other pathophysiological mechanisms has led to current therapeutic protocols and may be applicable in this setting.

Electroconvulsive Therapy↗
PubMed2003

Olanzapine treatment in chronic drug-resistant childhood-onset schizophrenia: an open-label study.

The use of typical antipsychotics is limited in children with schizophrenia, owing to the high rate of response failure and early appearance of extrapyramidal syndromes as well as tardive and withdrawal dyskinesia. The aim of the present study was to examine the effectiveness of the atypical antipsychotic olanzapine in the treatment of childhood-onset schizophrenia. The study sample included nine children hospitalized for schizophrenia who had proven refractory to treatment with at least two antipsychotic drugs. Olanzapine was administered after a 2-week washout period in gradually increasing doses to a maximum of 5 mg/day on day 5 and 10 mg/day in week 3; six patients received up to 20 mg/day as of week 5. The duration of the study was 12 weeks. Patient psychiatric status was measured with three scales at onset of therapy and thereafter once weekly. Patients also underwent regular blood, laboratory, and liver function tests, and we also monitored their blood pressure and weight and performed electrocardiography and electroencephalography. A reduction in all psychopathology scores was obtained at 12 weeks from baseline. All extrapyramidal symptoms of previous medications resolved, and there were no new incidents. Side effects were mild. There were no adverse changes in blood chemistry, hematological tests, or electrocardiography parameters, but the treatment was associated with a significant weight gain (6.10 +/- 3.25 kg). At 1-year follow-up, the improvement in psychiatric symptoms was sustained in eight children. We conclude that olanzapine may have potential as a first-line drug in the treatment of drug-resistant childhood-onset schizophrenia. Large-scale, double-blind, placebo-controlled comparative studies are needed to clarify the role of the various atypical antipsychotics in both treatment-resistant and treatment-naïve populations with psychotic symptoms/disorders.

Adolescent↗
PubMed2003

Plasma testosterone levels in patients with combat-related posttraumatic stress disorder.

BACKGROUND: An abnormal level of androgens has been reported in various psychiatric disorders and the important role of androgens in the regulation of human sexuality, aggression, cognition, emotions and personality have been described. Previous studies in the area of stress and the hypothalamic-pituitary-gonadal (HPG) system in humans indicate that circulating testosterone levels are suppressed by physical and psychological stress. However, there is also evidence that plasma levels of testosterone can increase during potentially stressful events and may be elevated in combat-related posttraumatic stress disorder (CR-PTSD) in comparison with normal subjects and major depressive disorder patients. METHODS: The aim of the present study was to examine the possible involvement of the HPG system in chronic untreated CR-PTSD. To this end, we assessed the morning plasma levels of testosterone and cortisol in never-treated chronic CR-PTSD outpatients compared with normal healthy controls. RESULTS: There were no statistically significant differences between the CR-PTSD patients and healthy control subjects in morning plasma testosterone (547.8 +/- 152.2 ng/dl vs. 565.6 +/- 122.4 ng/dl; p = 0.7) and cortisol (19.0 +/- 8.5 microg/dl vs. 15.4 +/- 5.1 microg/dl; p = 0.1) levels. However, a significant correlation between plasma testosterone level and avoidance symptom scores of the Impact of Events Scale (IES) was found in the CR-PTSD patients (r = 0.43, p < 0.05). CONCLUSIONS: The findings of plasma testosterone levels comparable with normal controls in CR-PTSD patients may indicate that the previously described reduction in testosterone levels in normal subjects under stressful conditions may reflect the acute stress response of the HPG axis, in contrast to an adaptation of the HPG axis under chronic psychological stress.

Adult↗
PubMed2003

Variability of color choice in the Lüscher Color Test--sex differences.

In this preliminary investigation of variability of responses on the Lüscher Color Test, subjects were 567 volunteers administered the test twice with a 10-min. interval between them. Two hypotheses were tested: (a) that variability of responses attests to the personality of the respondent (tested by the relations of variability and MMPI scale scores), and (b) variability of responses is based on learning the test's content. As such, men's scores should be more variable than women's. Analysis showed that variability was not correlated with scores for personality on the MMPI scales. Men's scores are more variable than women's, but only until age 45.

Adolescent↗
PubMed2003

The effects of clozapine versus haloperidol on measures of impulsive aggression and suicidality in chronic schizophrenia patients: an open, nonrandomized, 6-month study.

BACKGROUND: The risk of suicide for schizophrenia patients is 20 to 50 times higher than that for the general population. Long-term treatment with clozapine, an atypical antipsychotic, has been shown to reduce the rate of suicide by 80% to 85%. The goal of the present study was to examine whether clozapine's effect on the reduction of suicidal behavior in chronic schizophrenic patients could be due to a reduction in impulsive-aggressive behavior. METHOD: 44 patients with chronic DSM-IV schizophrenia were treated with clozapine or haloperidol decanoate in an open prospective 6-month trial. Changes in measures of suicidality, impulsiveness, aggression, depressed mood, and positive and negative symptoms were assessed at baseline and at 6 months. RESULTS: The clozapine-treated group (N = 18) had a significantly greater reduction on all outcome measures compared with the haloperidol decanoate-treated group (N = 26). Only in the clozapine-treated group did the reduction in measures of suicidality correlate significantly with a reduction in impulsiveness and aggression. The reductions in suicidality and impulsive aggression were not significantly correlated with reductions in depressed mood or positive and negative symptom scores in either group. CONCLUSION: These data suggest that the reduction in suicidality following long-term clozapine treatment may be related to a reduction in impulsiveness and aggression.

Adolescent↗
PubMed2003

Risperidone, but not olanzapine, decreases bone mineral density in female premenopausal schizophrenia patients.

BACKGROUND: The hyperprolactinemia induced by conventional antipsychotics often leads to osteoporosis. The commonly used atypical antipsychotics risperidone and olanzapine vary in their hyperprolactinemic properties. Therefore, we compared hormone profiles and bone properties in female premenopausal schizophrenia patients treated with either risperidone or olanzapine. METHOD: In a cross-sectional study, consecutive premenopausal, female, DSM-IV schizophrenia patients who were treated with either risperidone (N = 12) or olanzapine (N = 14) for at least 2 years were included. Dual energy X-ray absorptiometry evaluated bone mineral density, and multisite quantitative ultrasound measured bone speed of sound. In addition, profiles of urinary excretion of deoxypyridinoline and circulating levels of hormones and lipids were assessed. RESULTS: Serum prolactin levels were higher in the risperidone-treated group as compared with the olanzapine subjects (123 +/- 144 and 25.9 +/- 25.7, p <.05). Whereas bone mineral density was similar in the treatment groups, bone speed of sound was lower in the risperidone group as compared with the olanzapine-treated group. Expressed as age-adjusted Z score, bone speed of sound at the radius was -0.31 and 0.58, respectively, p <.05, and at the phalanx, -1.41 and 0.04, respectively, p <.05. The bone speed of sound in the risperidone-treated patients inversely correlated with urinary deoxypyridinoline excretion (r = 0.73, p <.05). CONCLUSION: Risperidone treatment, as opposed to olanzapine, for female premenopausal schizophrenia results in hyperprolactinemia and clinically relevant decrease in bone mineral density. The calculated relative risk for fragility fracture of women treated with risperidone as compared to those treated with olanzapine is 1.78 when bone speed of sound was measured at the phalanx and 1.23 when measured at the radius.

Absorptiometry, Photon↗
PubMed2003

[Complaints in mental health services in Israel: a one year-study].

Despite the growing awareness of mental patients of their rights, the number of complaints is still under-represented for different reasons including the patients' fear that they will be 'punished' because of their complaints or their lack of knowledge concerning the correct procedure and the appropriate address for issuing their complaint. This article presents the summary of one year's work (year 2001), on the complaints and letters we received at the Forensic Psychiatry Unit, Mental Health Services, Ministry of Health, from the general public, mental health patients, their families or Advocacy Agencies concerning mental patients' rights. We analyzed the complaints according to the topic, the process and the results of our interventions. The data collected on the complaints show that most of the complainants were the patients themselves, especially males and adults. Most of the complaints dealt with the patients' dissatisfaction with the type of treatment received, in that it did not match their expectations. Fifty percent of the complaints involved treatment received at psychiatric hospitals and 34% of the complaints were related to out-patient treatment. Sixty-five percent of complainants wrote a single complaint during the year 2001. Our intervention and reply to the complainants was completed within a month in 66% of the cases. We conclude suggesting different ways to improve this important service.

Community Mental Health Services↗