Biomedical subjects
Y Melamed
Publications and source records attributed to Y Melamed.
Who will protect mentally ill individuals from themselves?
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Human leukocyte antigen typing, response to neuroleptics, and clozapine-induced agranulocytosis in jewish Israeli schizophrenic patients.
The atypical antipsychotic agent clozapine is known to be effective in schizophrenic patients refractory to other medications; however, it induces agranulocytosis in approximately 1-2%. In Jews, this complication is associated with the haplotype HLA B38,DR4,DQ3. The aim of the present study was to determine which human leukocyte antigen (HLA) antigens are involved in clozapine-induced agranulocytosis. We performed HLA typing in 88 Jewish Israeli schizophrenic patients and in 127 ethnically matched healthy individuals. Thirty-eight patients responsive to standard antipsychotic medications were treated with haloperidol, and 50 refractory patients received clozapine. A trend was noted for elevated rates of HLA B38 among control individuals and clozapine-treated patients of Ashkenazi origin compared to individuals of non-Ashkenazi origin, but the findings failed to reach statistical significance. No association was found between HLA class I antigens and the response to haloperidol or clozapine. Neutropenia developed in two clozapine-treated patients and agranulocytosis in one. Two of these three patients were of Ashkenazi origin, and both demonstrated the HLA B38 phenotype. Although the findings did not reach a statistical significance because of the small number of patients, they may support an association between clozapine-induced neutropenia/agranulocytosis and Ashkenazi origin and the HLA B38 phenotype. The rate of agranulocytosis in our sample (2%) is similar to the usual cumulative risk of agranulocytosis but in contrast to its high frequency among Jewish American patients. One possible explanation for this difference is the high rate of Ashkenazi patients in the American sample and the preponderance of non-Ashkenazi patients in our population.
Superoxide anion production by neutrophils derived from peripheral blood of schizophrenic patients.
Evidence indicates that excess free radicals formation may occur in patients with schizophrenia. A study comparing the production of superoxide anion by peripheral blood neutrophils of 29 schizophrenic patients with that of 17 healthy volunteers detected a significant statistical increase in superoxide anion production in schizophrenic patients compared to the healthy control group. Despite the fact that oxidative mechanisms may play a role in schizophrenia, further studies are needed to define their involvement. Such studies would shed light on the etiology and pathogenesis of schizophrenia and may lead to new therapeutic approaches using antioxidants, which might partially alleviate or prevent the symptoms of schizophrenia.
Hyperbaric oxygen therapy in the pediatric patient: the experience of the Israel Naval Medical Institute.
UNLABELLED: The pediatric patient is to be found in hyperbaric facilities throughout the world, receiving hyperbaric oxygen (HBO) therapy for both life-threatening and chronic diseases. OBJECTIVE: To review the experience accumulated at the Israel Naval Medical Institute in the treatment of pediatric patients. DESIGN: A retrospective analysis and review of all records of patients younger than age 18 years. RESULTS: Between 1980 and 1997, 139 pediatric patients age 2 months to 18 years (mean, 7.7 years) received HBO treatment at the Israel Naval Medical Institute. Of the children, 111 (79%) suffered from acute carbon monoxide (CO) poisoning; 13 (9.2%) were treated after crush injury, traumatic ischemia, or compartment syndrome; 4 (2.8%) had clostridial myonecrosis; 1 (0.7%) had necrotizing fasciitis; 5 (3.6%) had refractory osteomyelitis; 2 (1.4%) had suffered massive air embolism; 2 (1.4%) had purpura fulminans; and 1 (0.7%) suffered from decompression sickness. Outcome, judged by neurologic sequelae, mortality, and extent of soft tissue loss and limb amputation, was favorable in 129 patients (93%). Two patients (1.4%) died, 1 as a result of CO poisoning and the other, gas gangrene; 2 of the patients in the CO group (1.4%) remained with neurologic sequelae, and 6 patients in the acute traumatic ischemia group (4.3%) underwent limb amputation. CONCLUSIONS: We had a favorable experience with 129 of a total 139 pediatric patients treated at our facility for the indications listed. A basic knowledge of HBO therapy is needed to refer the pediatric patient for treatment when indicated. The needs of the pediatric patient, especially the critically ill, require specific skills and equipment inside the hyperbaric chamber. Close collaboration between the pediatrician and the hyperbaric medicine physician is essential to ensure adequate care for infants and children.
The assassination of Yitzhak Rabin. Its impact on therapists and patients.
The tragedy of the assassination of the prime minister, Yitzhak Rabin, affected the entire population, regardless of individual mental states. The event influenced the therapeutic situation and gave rise to questions of the limitations and boundaries of treatment. The patients reacted and coped with greater or lesser intensity, according to their abilities, as did the rest of the population. The therapists encountered difficulties in their efforts to continue routine work while dealing with the influence of the event on the patients and on themselves. The attempts of an out-patient clinic to work and deal with these issues are discussed.
Risperidone treatment for a patient suffering from schizophrenia and IDDM.
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[Home care in psychiatry].
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Police attitudes toward mental illness and psychiatric patients in Israel.
The attitude of the public toward mental illness and toward psychiatric patients raises a serious and sensitive issue that indirectly affects the development of community mental health services. Most citizens feel that there is an association between mental illness and dangerous or violent behavior. Studies undertaken among police personnel in the 1970s demonstrated that their attitudes were similar to those of the general public in Israel. The objective of the present study was to assess the attitudes of police officers toward mental illness and psychiatric patients by means of a self-report questionnaire. Ninety-three policemen from five police stations within the Y. Abarbanel Mental Health Center catchment area participated in the study. All were young males (average age 32.1 years) and 75 percent had a high school education or higher. More than half (54.5%) had personally known a psychiatric patient in the past, and 20.4 percent of the police personnel graded mental illness as the severest form of disease in medicine. A minority (14.3%) of policemen agreed with the statement: "A psychiatric hospital should be fenced and manned by guards." One-third did not know whether psychiatric patients are dangerous. We conclude that training of police officers is called for to effect changes in their misconceptions about psychiatric patients. Psychoeducation may lead to improved handling by the police of incidents involving the mentally ill.
Alterations in R-R variability associated with experimental motion sickness.
Motion sickness is a complex integration of responses from multiple physiological systems. Whether the changes that occur during the time course of motion sickness are mediated by the sympathetic or parasympathetic systems is still controversial. The present study evaluates alterations in R-R variability during experimental motion sickness in motion sick and non-motion sick subjects. Ten motion sick subjects and 7 non-motion sick subjects participated in the study. Power spectrum analysis of R-R variation was conducted for all subjects 10 min before a brief vestibular disorientation test (BVDT), for 5-10 min of the test, and 10 min after the test. Subjects were also asked to report their symptoms during the test. The motion sick group showed a significant reduction in the power spectrum density of the R-R interval at the mid and high frequencies during the BVDT test period (BVDT), in comparison with the rest period (Rest). These changes probably indicate a decrease in parasympathetic activity during the time course of motion sickness. The non-motion sick group did not show significant differences at any of the frequencies during BVDT. Power spectrum analysis of the R-R interval provides an objective measure of the autonomic response to experimental motion sickness.
[Between "transparent room" and "sealed room:" professional confidentiality and therapeutic judgement].
Patients and therapists are concerned with the complexities of protecting medical confidentiality. The traditional perception of protection of patient confidentiality is that the individual's interest in protecting his confidentiality may conflict with the public's need for information, especially in cases involving possible danger. In fulfilling his dual role of representing both the patient and the public, the therapist acts according to existing laws and regulations. We describe 3 cases in which refraining from providing the Army with information in accordance with the law was recognized in retrospect as having caused the patient suffering, and even danger. It is recommended that the therapist's judgement be considered in addition to other legal criteria for determining whether or not to protect patient confidentiality.
Helium and oxygen treatment of severe air-diving-induced neurologic decompression sickness.
BACKGROUND: The use of helium and oxygen recompression treatment of neurologic decompression sickness (DCS) has several theoretical advantages over the traditionally used air and oxygen recompression tables that have been confirmed by findings from recent animal experiments. OBJECTIVES: To evaluate the outcome of patients with neurologic DCS who had been treated with a helium-oxygen protocol and to compare it with that of a retrospective control group that was treated with air-oxygen tables. DESIGN: The study and control groups included 16 and 17 diving casualties, respectively. The severity of neurologic DCS was estimated according to a 9-point scale weighting motor, sensory, and sphincter control functions. The study group was treated with a helium-oxygen decompression protocol, and the control group was treated with the US Navy air-oxygen Table 6 or 6A. Persistent residual dysfunction was treated in both groups with daily hyperbaric oxygen sessions, at 2.5 absolute atmospheres for 90 minutes, until no further clinical improvement was noted. SETTING: The Israel Naval Medical Institute (Israel's national hyperbaric referral center), Haifa. RESULTS: Significant clinical score increments were found for both the helium-oxygen- and air-oxygen-treated groups: 2.8 +/- 2.4 (mean +/- SD) and 7.4 +/- 1.1 at presentation vs 7.6 +/- 2.1 and 8.1 +/- 1.5 at discharge, respectively (P < .001 and P = .005, respectively). Although the score at presentation was significantly lower for the helium-oxygen-treated group (P < .001), no difference was found between the groups' average outcome scores. While most of the improvement in the patients in the study group could be attributed to the helium-oxygen treatment and not to the supplemental hyperbaric oxygen, in the control group, no significant difference could be demonstrated between the scores at presentation and at completion of the air-oxygen recompression table. In 5 patients who were treated with the use of the air-oxygen tables, deterioration was observed after recompression. No deterioration or neurologic DCS relapse occurred in the helium-oxygen-treated group. CONCLUSION: The results suggest an advantage of helium-oxygen recompression therapy over air-oxygen tables in the treatment of neurologic DCS.
Modification of in vivo and in vitro TNF-alpha, IL-1, and IL-6 secretion by circulating monocytes during hyperbaric oxygen treatment in patients with perianal Crohn's disease.
Treatment of perianal inflammatory lesions in Crohn's disease (CD) is unsatisfactory and novel treatment modalities are pursued. We have recently reported a good clinical effect of hyperbaric oxygen (HBO) treatment in perianal CD. In the present study, seven patients with perianal CD were subjected to daily sessions of HBO in a multiplace hyperbaric chamber. Each patient received a total of 20 sessions during a time period of 1 month, and IL-1, IL-6, and TNF-alpha measurements were done several times during the initial sessions and after completing therapy. Pretreatment cytokine levels were elevated in patients compared to age-matched 10 normal controls. During the first 7 days of treatment, IL-1, IL-6, and TNF-alpha levels in supernatants of LPS-stimulated monocytes derived from patients' peripheral blood were decreased compared to pretreatment levels. Parallel measurements of serum IL-1 levels revealed an initial elevation and thereafter decreased levels, which remained low throughout the first week of HBO treatment. After completion of therapy, cytokine levels increased to pretreatment values. We conclude that alterations in secretion of IL-1, IL-6, and TNF-alpha may be related to the good clinical effect of HBO treatment in CD patients with perianal disease.
Erotomania following an orchiectomy: a case report.
A case report of young male patient with erotomania following seminoma and orchiectomy is described in this article. The probable dynamics that lead to this delusion are then discussed. This case report demonstrates the cooperation between the oncology ward and the psychiatric liaison service.
Voting by Israeli patients.
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Hospitalized mentally ill patients in Israel vote for the first time.
For the first time in Israel, hospitalized mentally ill patients were enabled to participate in the election of the prime minister and members of the Knesset (Israeli parliament) held on May 29, 1996. In a demonstration election held in Yehuda Abarbanel Hospital to teach and prepare the patients to vote, the outcome of the vote for the prime minister was identical to the results of the general public vote. The sample vote results for members of the Knesset were slightly different from those in the actual election. The character of the voting in this sample bolsters arguments for the rights of mentally ill individuals to participate in the basic democratic process of voting and should ease any misgivings felt by some of the public about their ability to vote as rationally as other members of the public.
The views of psychiatric patients and their treating physicians of court-ordered compulsory hospitalization for criminal acts.
The legal responsibility for the mentally ill has long been a dilemma. Public opinion regarding the law which states that the mentally ill, in a psychotic state, are not responsible for their actions, is divided. The study assessed 30 psychiatric patients, committed by court order, following a criminal act on their part. No relationship was found between the nature of their offense and a psychiatric disorder. Patients who committed more serious crimes, such as murder, tended to have committed fewer criminal acts in the past. Sixty-nine percent of the patients think that the mentally ill are not responsible for their actions and 59% agreed with the judge's decision to hospitalize them. On a concrete level, over two-thirds of the patients were able to distinguish right from wrong. The treating physicians related mainly to the patients' illnesses rather than to the crimes for which they were committed.