Israel Journal of Psychiatry and Related Sciences最新文献

Introduction: Although hepatitis C virus (HCV) is associated with substance abuse, treatment of addicts is problematic. We report the results of a pilot scheme for treatment of HCV - infected substance abusers in a methadone maintenance center (MMC).

Methods: The treatment program was carried out at a single MMC. Patients were not using illicit drugs or alcohol and received regular treatment with methadone. The program consisted of 5 stages: 1. An explanatory lecture concerning HCV (50/114 attended). 2. 25 of the 50 presented for examination including HCV RNA, genotype and viral load. 3. HCV treatment with pegylated alfa-interferon-1b and ribavarin. 4. The MMC physician and staff aided the clients' medical compliance. 5. A hepatologist (SM) volunteered his services on the basis of one 3 hourly session every 4-6 weeks, in addition to open access telephone consultation with the MMC staff physician.

Results: 50 of 114 HCV seropositive clients attended the initial meeting , 25 (50%) were candidates for treatment, of whom 20 were treated. 10 had genotype 3 infection, 9 genotype 1 and 1 genotype 2. The sustained virological response (SVR) on an intention-to-treat basis was 8/20 (40%).

Discussion: We present a model for the successful treatment of chronic HCV hepatitis in patients receiving methadone.

Background: Cultural differences in serious eating problems among adult women have important treatment and prevention implications yet remain relatively unexplored. This is the first study to examine these issues among Israel's multi-cultural adult population.

Method: Disordered eating behaviors (DEB) are assessed with 14 DSM-related symptoms (including binge eating) in a multi-cultural sample of 485 women. Prevalence rates and clinical predictors of DEB severity are examined for three culturally distinct groups of Jews.

Results: Second generation Israeli-born and first generation Israelis of Sephardic and Ashkenazi origins differ significantly in DEB prevalence (19.4%, 11.4%, 13.9%, p<.05). Regarding clinical predictors, self-criticism is strongest predictor for second generation while weight is strongest predictor for both first generation groups.

Conclusions: Prevailing wisdom largely attributes eating disturbances to cultural thinness norms. However, substantial differences between culturally distinct groups of Israeli Jews, similarly exposed to westernized norms, challenge the prevailing wisdom. Culturally sensitive interventions warrant additional research and more illuminating explanatory models than "one size fits all."

Objective: To explore the notion that difficulties in metacognitive functioning are a core pre-psychotic feature of emerging schizophrenia and its spectrum.

Method: Seventy-eight help-seeking, non-psychotic adolescents (age 13-18) were assessed with the Prodromal Questionnaire (PQ), the Structured Interview for Prodromal Syndromes (SIPS), two scales of social and role functioning, and a metacognitive version of two non-social (verbal memory and executive functioning) and two social (facial emotion perception and Theory of Mind) cognition tasks. In addition to the standard administration of the tasks, subjects were also asked to rate their level of confidence in the correctness of each answer, and to choose whether they wanted it to be "counted" toward their overall performance score on the task. Each "volunteered" response received a bonus of 5 cents if correct, but an equal penalty if wrong.

Results: Levels of cognitive and metacognitive functioning were not significantly different between subjects at high versus low risk. However, the prediction of psychosocial functioning reached significance when adding the novel metacognitive measures to the conventional measures of cognitive and social-cognitive abilities.

Discussion: These results challenge the robustness of the link between neurocognitive deficits and risk for schizophrenia. However, they suggest that metacognition plays an important moderating role in the association between neurocognition and functional outcome before acute onset of the illness.

Background: Repeated nicotine administration induces neuro-adaptations associated with abnormal dopaminergic activity. These neuronal changes may contribute to impaired inhibitory control and attention deficit. However, it remains unclear whether smokers perform worse than non-smokers on tests that involve attention and control of impulsivity. The present study examined response inhibition and sustained attention capacities in a large sample of smokers and non-smokers.

Methods: Continuous Performance Test (CPT) and Go/ NoGo computerized tasks were used as a measure of response-inhibition ability and sustained attention. Threeway repeated measures analysis of covariance was used with response time, variability of response time, number of commission errors (inappropriate responses to stimuli) and number of omission errors (missed stimuli) as dependent measures. Main effects were: group (smokers and controls), condition (CPT and Go/NoGo), and block (in each condition); gender, education, and age were used as covariates.

Results and conclusions: Smokers, as compared to the control group, made more errors of commission in the Go/ NoGo task, reflecting impaired inhibition ability. However, we found no significant differences between the groups in our measure of sustained attention. Impaired response inhibition was found to co-occur with heavy smoking and therefore may be a potential target for the development of more effective cessation programs.

Hallucinogen Persistent Perceptual Disorder (HPPD) is a clinical syndrome characterized by the recurrence of distressing perceptual disturbances which previously emerged during primary hallucinogen intoxication, in the absence of recent use. Here we present two patients who developed HPPD following use of Synthetic Cannabis Substances (SCS), with no prior history of natural-occurring or synthetic hallucinogen use. Both cases had a prior history of cannabis dependence and current tobacco dependence. In both cases patients reported the presence of visual disturbances when smoking SCS and staring at stationary and moving objects. Both patients discontinued SCS use abruptly after suffering from a panic attack under the influence of SCS. Despite cessation of SCS, both patients continued to suffer from HPPD which was accompanied by significant anxiety. Following clonazepam treatment, both subjects reported significant improvement in symptoms and remained with a residual focal visual disturbance which was not accompanied by significant anxiety. To the best of our knowledge these are the first reports of HPPD following SCS use. In light of the increasing use of SCS, clinical psychiatrists should be aware of these perceptual side effects.

Institutional ethics committees were established and functioned in Israel prior to the application of the Patients Rights Act of 1996. These committees were voluntary and comprised of multidisciplinary teams in order to obtain numerous viewpoints stemming from various different fields. This intent was based on an understanding that the issue of ethics and the process of making ethical decisions inherently address moral and social considerations which are beyond the realm of medical practice. In contrast to the voluntary institutional ethics committees, the Patients Rights Act of 1996 instituted statutory ethics committees. These committees were mandated to investigate defined areas and, in contrast to the former committees that were considered to be valuable as advisory and enlightening entities, their decisions are binding. However, it appears that the utilization of these ethics committees within the domain of mental health facilities is limited in scope and their use varies greatly between institutions. The employment of these committees in mental health institutions focuses mainly around issues that relate to information management and mentally ill patients' refusal of medical treatment. Several explanations exist for this phenomenon. Suggestions as to how the situation may be remedied are addressed as well as the complementary role that these ethics committees may play in modern day clinical practice.

Background: To date, many studies have been published regarding the safety of antidepressant use in pregnancy. However, most have been regarding a possible association with major malformations and there have been relatively few studies that have examined other infant outcomes specifically.

Objective: To evaluate possible adverse effects of antidepressant use in pregnancy.

Methods: We searched the literature, using Medline, PUBMED, Embase, and Reprotox , and retrieved key articles and reviews of the topic.We examined all outcomes with the exception of major/minor malformations.

Results: We did not find an overall increased risk associated with lower mean birthweight, small for gestational age or long-term neurodevelopmental adverse outcomes. However, there does appear to be a significantly increased risk for spontaneous abortion, preterm birth and low birthweight less than 2,500 gm. In addition, a possible increased risk for Persistent Pulmonary Hypertension of the Newborn (PPHN) and evidence of Poor Neonatal Adaptation Syndrome (PNAS) following use in late pregnancy. All of the observed risks were of a very low magnitude and the clinical significance of these results is unknown.

Conclusions: This information should not preclude a pregnant women from being treated for depression if required, as untreated depression is also associated with adverse effects on the infant.However, further research needs to be conducted where it is possible to control for maternal depression, in order to evaluate whether these adverse events are due to the underlying maternal illness, the antidepressant, or possibly a combination of both.

Maternal exposure to second generation antipsychotics during pregnancy has been associated with some negative effects for both mothers and infants. Aripiprazole is becoming more readily used, although data regarding its use in pregnancy are limited. Additionally there are limited data with regards to the impact of polypharmacy on pregnancy outcomes. Given the relative paucity of information related to aripiprazole use in pregnancy it is difficult to counsel women on potential risks or side effects. We present two cases that illustrate the use of aripiprazole as a part of a polypharmacy regimen in pregnancy and describe the pregnancy outcomes in an effort to help clinicians facing complex treatment decisions in pregnancy.

Background: Recent epidemiological studies have reported a world-wide increase in the rates of alcohol use among adolescents. Research has shown a strong link between alcohol abuse and psychiatric disorders. This study explored the clinical and demographic correlates of adolescents with a history of alcohol abuse (AA) compared to adolescents with no history of alcohol abuse (NAA) among a group of adolescent psychiatric inpatients in Israel.

Method: Two hundred and thirty-eight subjects were screened, all were patients consecutively admitted to an adolescent inpatient unit at a university-affiliated mental health center in Israel during a 4-year period

Result: Patients in the AA group were more prone to have a history of suicide attempts and self-injury compared to patients in the NAA group. Prevalence of attentiondeficit disruptive behavior disorders was more common in the AA group, and these patients were more prone to have a history of criminal activity and drug use. Median length of hospitalization was greater in the NAA group.

Limitations: Limitations concerning attribution of causality due to the cross-sectional nature of this study.

Conclusion: Higher prevalence of criminal behavior, selfinjury and suicide attempts associated with alcohol abuse may be related to higher levels of impulsivity, indicated by higher prevalence of attention-deficit disruptive behavior disorders. Alcohol-related disorders should be carefully screened and addressed in adolescent psychiatric units and in consequent ambulatory treatment settings.