Israel Journal of Psychiatry and Related Sciences最新文献

Objective: The purpose of the present study was to assess the relationship between various domains of cognitive functions, the intensity of psychopathological symptoms, and the general functional outcome in adolescents with early-onset schizophrenia.

Method: 33 adolescents with early-onset schizophrenia (EOS) were investigated in their partial symptom remission period. The control group consisted of 30 healthy adolescents. Schizophrenia was diagnosed on the basis of ICD-10 criteria. Psychopathological symptoms were assessed with the use of the PANSS (Positive and Negative Symptoms Scale) scale. General functioning was evaluated with the use of the CGAS (Children's Global Assessment Scale) scale.

Results: Significant dysfunctions of various aspects of working memory, executive functions, and verbal memory were found in the group of EOS adolescents, as compared to the control group. Working memory and executive function deficits were significantly more severe in patients with a greater intensity of negative schizophrenia symptoms. EOS patients with a familial burden of psychosis presented greater cognitive deficits than patients without such a burden.

Conclusions: These data suggest that visual working memory and verbal memory deficits with a higher intensity of negative and positive symptoms proved to be significant predictors of poor functioning. Limitations of the study are discussed.

Depression in pregnancy is characterized by unrealistically heightened perception of teratogenic risk. Appropriate counseling regarding the exposure at hand can assist in reducing maternal concerns. Addressing depression during pregnancy and, in parallel, providing evidence based counseling and reassurance regarding different antidepressants in pregnancy may avert major health risks.

Background: Studies from recent decades indicate that the ideal of thinness can be discerned in a growing dissatisfaction with weight and an increase of the prevalence of disordered eating at an earlier age of onset.

Objective: The purpose of this study is to evaluate the prevalence of disordered eating (above the cutoff point of 30 on the EAT-40) among a normal population of school students in Israel.

Methods: The study sample was composed of Israeli (Jewish) adolescents in grades 7 to 12 from four schools. Of 326 students approached (181 females and 142 males), 323 completed the self-report EAT-40 and a structured questionnaire that provided socio-demographic and other information.

Results: 41.5% of adolescents were not satisfied with their weight and 45.3% want to lose weight. A third of the sample engages in dieting behavior frequently; 6.1% of the adolescents have pathologic EAT-40 scores, with about three times as many girls as boys exhibiting disordered eating; 8.2% of the girls and 2.8% of the males show disordered eating (Ø=0.115, p <0.05). Among adolescents who are dissatisfied with their weight there are 7.6 times more with pathologic EAT scores than those who are satisfied with their weight (Ø=0.220; p <0.01). There are 10.8 times more pathologic EAT scores among adolescents who wish to lose weight than among those who do not wish to reduce their weight (Ø=0.237; p <0.01). No significant differences in pathologic EAT scores were found among adolescents from different ethnic backgrounds or levels of religious observance.

Conclusion: The prevalence of disordered eating among adolescents in Israel is higher than other countries in general, and among males in particular. There is a need for increased efforts to detect adolescents at risk for developing eating disorders, with the assistance of clinical tools. In addition an educational policy for disordered eating prevention should be instituted.

Deficits in metacognitive capacity in schizophrenia can be conceptualized as existing along a spectrum from more discrete to more synthetic activities. While each represents an equally important focus of study, synthetic metacognitive activities may be more difficult to measure given they are more a matter of assessing complexity of thought rather than concrete accuracy; and therefore have received less attention. This review summarizes research on synthetic metacognition using a paradigm in which metacognitive capacity is rated within personal narratives. Results across the work reviewed here provides evidence that these deficits are detectable in patients with schizophrenia and that deficits are related to, but not reducible to, symptom severity and poorer neurocognitive function. Independent of symptoms and neurocognition, deficits in synthetic metacognition are related to a range of mental activities including reasoning style, learning potential and insight. These deficits may also play a role in long term outcome via their impact on the ability to function in work settings and to think about and sustain social connections.

Background: Several developments in diagnosing night eating syndrome (NES) occurred during the last decade. New proposed diagnostic criteria are now available, and a short Night Eating Questionnaire (NEQ) was published. The study aims were to validate the NEQ for assessing NES, to identify the optimal NEQ cut-point for NES diagnosis, and to validate and test the internal reliability of the translated Hebrew version of the NEQ.

Method: 141 participants completed the questionnaire and a diagnostic interview, divided into four groups: NES (n=59), Partial diagnosis PD-NES (n=42), other eating disorders (n=8) and controls (32). Validity was measured by calculating reliability, factor structure, and comparing the interview diagnosis to the NEQ score using different cut scores.

Results: Cronbach's alpha was 0.78, and principal components analysis yielded a five factor structure. A cut score of 21 provided the best balance of false and true positive diagnosis.

Conclusions: We concluded that the NEQ may be an acceptable screening instrument for assessing NES symptomatology.

Background: Opioid dependency is characterized by repeated use of an opioid drug despite physical dependence, behavioral impairments and social dysfunction. Therapeutic approaches for the treatment of opioid dependence are total abstinence and opioid agonist maintenance treatment (OAMT). Opiate agonist maintenance therapy is administered using opioid replacement pharmacological agents, i.e., methadone or buprenorphine. Methadone acts as a full opiate agonist while buprenorphine acts as a partial agonist. Strict supervision is necessary when dispensing methadone, because overdose can be fatal. Buprenorphine associates with opioid receptors slowly but with high affinity, and dissociation from the receptor site is (pseudo) irreversible. It is safer than opioid full agonists such as methadone.

Methods: We probed the therapeutic efficacy of buprenorphine using a retrospective evaluation of numerical data in the first private buprenorphine clinic in Israel. Data was collected for all patients attending the clinic in December 2012. Our indicator for treatment success is retention in the program.

Results: During the years 2005-2012, 1,399 individuals approached the clinic; 1,224 (87.5%) of them attended the clinic at least twice; treatment adherence in this group was 66.5 % at the end of one year.

Conclusions: The success rates of patients who are treated with buprenorphine and are able to eventually return to their families and re-enter the workforce is encouraging. Thus, the community based minimal intervention treatment model using buprenorphine for the treatment of opiate dependence is a viable treatment option in the war against opiate abuse.

The evolving field of behavioral genetics is gradually elucidating the complex interplay between genes and environment. Scientific data pertaining to the behavioral genetics of violent behavior provides a new context for an old dilemma regarding criminal responsibility and punishment: if the inclination to violent behavior is inherent in someone's nature, how should it affect punishment for crime? Should it be considered as a mitigating or an aggravating factor? Given psychiatrists' increasing involvement in providing testimony on behavioral genetics in the criminal justice system, this paper first provides the necessary background required for understanding how this question arises and reviews the relevant literature. Then, we address this question from the perspective of the Bible and its commentators, in the belief that their insights may enrich the contemporary discussion of this question.

Background: Participation of the mentally-ill in elections promotes integration into the community. In many countries, individuals with compromised mental incompetence who have legal guardians are denied the right to vote. In Israel, mental health consumers are eligible to vote. We evaluated the capacity of psychiatric inpatients with and without legal guardians to understand the nature and effect of voting.

Methods: Fifty-six inpatients with/without legal guardians were recruited to the study. Participants completed the Competency AssessmentTool for Voting (CAT-V), Brief Psychiatric Rating Scale and the Mini-Mental State Exam.

Results: Cluster analysis determined voting capacity using CAT-V as a continuous variable. Subjects who scored >1.6 on the CAT-V (59%) had high capacity to vote. Subjects without guardians revealed significantly higher capacity to vote. Voting capacity positively correlated with cognitive state and negatively correlated with severity of illness. Among patients with legal guardians those who scored >1.6 on the CAT-V maintained the capacity to vote.

Conclusions: The right to vote is an important basic right for individuals coping with mental disorders.However, it is important to evaluate the capacity to understand the voting process among individuals with mental disorders who have legal guardians. Thus, the integrity of the elections would be preserved by eliminating the risk of undue influence or manipulation of individuals who lack the capacity to understand the nature and meaning of voting, while preserving the right to vote for those with the capacity to do so, whether or not they have guardians.

Background: Patients' decisions in relation to participation in clinical research depend on individual values and relevant outcomes. Presenting possible decisions by way of defaults (opt-in or opt-out) has been used to achieve desired outcomes. Our objective was to characterize patients willing to participate in clinical research and to assess the impact of defaults on patients with Serious Mental Illness (schizophrenia, schizoaffective disorder, major depression and bipolar disorder; SMI) during the decision process.

Methods: Patients with SMI were requested to accept or reject participation in a novel drug treatment study using either the (1) opt-in condition, wherein they were told that our center's policy is not to include them in drug studies; (2) the opt-out condition, wherein they were told that our center's policy is to include them in drug studies; and the (3) neutral condition that required patients to state their preference with no prior information.

Results: 311 patients with SMI completed the brief questionnaire within 48 hours of admission to a psychiatric ward. There were 227 (73%) patients suffering from schizophrenia and schizoaffective disorder, 40 (13%) suffering from bipolar disorder and 44 (14%) suffering from major depressive disorder. There were 156 men (50%) and 155 women in the sample, mean age 47.8±16.2 years. In the opt-in condition, 58% abstained, while 42% opted-in (p=0.003). In the opt-out condition, 58% participated, while 42% opted-out. In the neutral condition 51% indicated willingness to participate, 33% refused and 16% were undecided. The "willing" patient was characterized by younger age, previous hospitalizations, affective illness and more comorbid physical disorders.

Conclusion: Taken together these findings reveal the "profile" of patients with SMI willing to participate in clinical research and demonstrate an increase in participation preferences through the use of defaults.

Background: While research has shown that maternal mood (depression and/or anxiety) can have effects on the fetus, little is known about whether maternal positive and negative affect influences the fetus.

Method: We examined fetal vascular and heart rate changes at 36 weeks gestation in 53 euthymic mothers according to their Positive and Negative Affect Scale (PANAS) scores.

Results: Mothers who reported high levels of negative affect showed reduced uterine artery flow, decreased fetal heart rate (fHR) variability, an altered diurnal pattern, and decreased uterine artery cross-sectional area compared to mothers who reported low levels of negative affect. Mothers with low positive affect had a steeper diurnal pattern in fHR accelerations and decreased uterine artery mean velocity flow than mothers with high positive affect.

Limitations: Our observational study suffers from a small sample size.

Conclusion: Even in the absence of an Axis I Major Depressive Disorder (MDD), variations in maternal affect appear to be associated with variations in fetal and uterine physiology.