Israel Journal of Psychiatry and Related Sciences最新文献

Background: Gender differences have often been found in psychopathological symptoms among chronic schizophrenia and first-episode psychosis (FEP) patients. However, many of these studies suffer from methodological problems and show inconsistent results. Furthermore, very few studies have investigated gender differences in individuals with an at-risk mental state (ARMS) for psychosis.

Methods: Psychopathological symptoms were assessed in 117 ARMS and 87 FEP patients by two observer-rated scales, namely, the expanded version of the Brief Psychiatric Rating Scale (BPRS) and the Scale for the Assessment of Negative Symptoms (SANS), and by one self-report scale, the Frankfurt Complaint Questionnaire (FCQ). Gender differences were investigated by applying Analyses of Variance using the BPRS, SANS and FCQ subscales as dependent variables, and group and sex as between-subject factors - in a second step by including age, antipsychotic, antidepressant and cannabis use as covariates.

Results: There were no significant gender × patient group interactions, suggesting that gender effects did not differ between patient groups. Women had higher scores in positive psychotic symptoms (BPRS Psychosis/ Thought Disturbance) while men had higher scores in negative symptoms (BPRS negative symptoms, SANS total score, as well as subscales Affective Flattening, Avolition-Apathy and Asociality-Anhedonia). However, the differences did not withstand correction for multiple testing. The results did not change when corrected for potential confounders.

Conclusions: There do not seem to be any gender differences in psychopathology, neither in ARMS nor in FEP patients, as regards self-reported or observerrated symptoms, when corrected for multiple testing and potential confounders.

Introduction: Antenatal anxiety and depression occur in approximately 20% of pregnant women with potentially deleterious effects to mother and child. While effective in reducing symptoms, some pregnant women are often reluctant to take psychotropic medications. We tested the effectiveness of group therapy to provide worry and depression symptom relief.

Methods: Women (N=38) in 15-28 weeks of gestation were recruited to antenatal Psychotherapy Groups using either interpersonal or mindfulness based therapy. We collected data at three times, upon intake to and at completion of the group and at four weeks postpartum. Descriptive, Chi-square, and GEE analyses were used to compare depression and worry symptoms with a matched control group of pregnant women (N=68).

Limitations: Small sample size in both groups required a matched control group with no randomization.

Results: Attending group therapy significantly reduced worry and depression symptoms over pregnancy into the postpartum compared to women receiving no therapy. There was no difference in symptom reduction between different types of groups attended.

Discussion: Engaging pregnant women in group therapy can significantly improve worry and depression symptoms, with lasting effects.

A side effect associated with the use of synthetic hallucinogens such as lysergic acid diethylamide-(LSD) is the partial or total recurrence of perceptual disturbances which previously appeared during intoxication, despite absence of recent use. These are commonly referred to as "flashbacks" or Hallucinogen Persisting Perception Disorder (HPPD). Here we present two cases of patients with a prior history of LSD use who turned to psychiatric consultation following brief episodes of HPPD. Surprisingly, in both cases new visual imagery appeared during episodes of flashbacks which was not experienced during primary LSD use. Both subjects reported the ability to discern between LSD-associated visual disturbances and new visual imagery. This phenomenon did not cause functional impairment and in both cases caused gradual concern due to its persistence. Both patients refused medical treatment and continued psychiatric follow-up. At one year follow-up both patients reported almost complete spontaneous remission. To the best of our knowledge these are the first reported cases of LSD-related benign flashbacks in which new imagery is experienced. Reasons for this reversible and apparently harmless side effect are proposed. Conclusions from case reports should be taken with caution.

Prior to the development of the pharmaceutical industry and the advocacy of evidence based medicine in the late 20th century, placebo treatments were commonly used by physicians. In current clinical practice, neither a physician's confidence in the efficacy of a specific treatment nor his personal ethical norms are any longer sufficient to initiate a given therapy. We will discuss whether placebo treatments can be ethically used in clinical practice as an alternative to standard therapy, and propose an innovative conceptualization of the factors involved in the exclusion of placebo treatments from the clinical setting. Patient-related ethical and interpersonal arguments and physician-related legal and ideological arguments concerning placebo usage are presented. We describe current use of placebo treatments in the healthcare system and suggest that placebo therapy thrives and that its therapeutic efficacy is widely acknowledged. There is currently "underground" use of placebo medication, open label placebo trials, and innovative approaches to informed consent to facilitate ethical prescription of placebo therapy. Finally, using the specific example of treatment for depression, we demonstrate how the arguments against placebo use might be undermined, to retrieve the legitimacy of placebo therapy.

Objective: To assess and compare negative emotional eating among individuals with and without Night Eating Syndrome (NES) and Binge Eating behavior (BE).

Method: The sample consisted of 76 obese participants, who were divided into four groups: the NES Only group; the BEOnly group; the BE and NES group; and the overweight control group with neither BE or NES.

Results: RESULTS showed significantly higher negative emotional eating among the BEOnly group, whereas those with NES Only did not report eating in direct response to negative emotions and situations.

Discussion: RESULTS suggest that individuals with BE may be using food as a maladaptive coping mechanism, while individuals with NES eat in the evening hours as a way to avoid the experience of negative emotions.

Background: While chronic persecutory delusions are typically anchored into patients' everyday life situations, no investigation has ever looked at how situations associated with a feeling of persecution are recorded and later retrieved.

Method: a diary methodology combined with a recognition task involving ten patients with schizophrenia who presented chronic persecutory delusions and ten control participants. Diaries of everyday persecutory events (Pe) and non-persecutory events (nPe) were kept.

Results: in both groups, 1) Pe were associated with higher anxiety scores than nPe, 2) Pe were experienced as less distinctive and more stereotyped than nPe, 3) the frequency of incorrect recognition of altered descriptions of Pe was higher than that of nPe.

Limitations: because high levels of motivation are required of the diarists, our sample size was small.

Conclusion: Memories of persecutory events were highly emotional and semanticized. they were frequently incorrectly recognized, suggesting the existence of bias resulting from interactions between their processing and persecutory delusions.

Objective: The current study examined a mediation model in which symptoms of schizophrenia and schizotypy traits mediate the positive relations between metacognition and Social Quality of Life (SQoL) among persons with schizophrenia and persons without mental illness.

Method: 39 persons diagnosed with schizophrenia and 60 persons without a severe mental illness diagnosis participated in this study. Instruments included the Metacognition Assessment Scale-Abbreviated (MAS-A), the SQoL scale of the QLI-MH, the PANSS scale and the O-LIFE self-report questionnaire that assesses schizotypy traits.

Results: Persons with schizophrenia exhibit lower SQoL and metacognitive abilities than persons without mental illness. For persons with schizophrenia, negative symptoms mediate the positive relation between the ability to understand other persons' minds and SQoL. However, although for persons without mental illness, understanding other minds was found to correlate negatively with introvertive anhedonia and SQoL, a mediation model was not confirmed.

Discussion: Understanding of others' minds seems relevant to the SQoL for both samples. In addition, negative symptoms of schizophrenia and introvertive anedonia traits are also related to SQoL among persons with schizophrenia and among persons without mental illness respectively. The lack of support for a mediation model for persons without mental illness is consistent with the theories that claim schizotypy is not a mirror image of schizophrenia and, therefore, may not necessarily lead to schizophrenia. Limitations of this study and suggestions for future research are discussed.

Background: In contrast to postpartum depression, postpartum anxiety receives less attention, especially in the general population. Acknowledging the phenomenon is important, as it may lead to significant distress and impair maternal functioning.

Objectives: To explore the phenomenon in a cohort of women in the general population and to investigate possible associated factors.

Methods: Within the first days after childbirth, women at Chaim Sheba Medical Center maternity ward were interviewed. Questionnaires included psychosocial variables, feelings and fears during pregnancy and childbirth, and the Edinburgh Postnatal Depression Scale (EPDS) (referring to the last week before delivery). A month later, subjects completed the EPDS, a modified Spielberger Anxiety Scale and the Posttraumatic Stress Diagnostic Scale via telephone.

Results: 40.4% had high anxiety scores. A significant association was noted between postpartum anxiety and depression during the last week of pregnancy, postpartum depression, as well as postpartum PTSD. Anxiety scores were almost 50% higher in those who suffered from postpartum PTSD compared to those who experienced postpartum depression. Associations were also found with fear of the birth, fear of death during delivery (mother and fetus), feeling lack of control during labor and less confidence in self and medical staff. Of women who developed postpartum anxiety, 75% reported feeling anger, fear or emotional detachment during childbirth. No association was found with birth complications.

Conclusions: Anxiety symptomatology appears to be a common manifestation after childbirth. It is therefore important to inquire about depression and fears during pregnancy and childbirth and subjective experience in order to anticipate postpartum anxiety symptoms, even by means of a brief screening test. The finding that postpartum PTSD was associated with the severity of postpartum anxiety may be used in the future as a potential identifier of PTSD symptoms in women with high anxiety scores.

Background: Compliance and impact of a time-limited brief intervention (BI) for reducing exposure to alcohol, psychoactive substances and nicotine among women admitted to the hospital during pregnancy were assessed.

Methods: Pregnant women (gestational week ≤30) from a medical center pre-delivery, emergency and high-risk units were interviewed about alcohol (AUDIT and TWEAK questionnaires), smoking (modified Fagerström) and psychoactive substance (modified ASI). All exposed women were invited to participate in a BI and underwent follow-up. Characteristics and rate of exposure were compared to a "standard-group" of non-selected women who arrived to the hospital directly solely to give birth.

Results: Forty-six of the 108 study participants (42.6%) were exposed to smoking (85%), alcohol (41%), or drugs (39%), and 41 underwent the BI. Self-report of exposure was reduced significantly following BI but re-elevated post-delivery. Women belonging to the "standardgroup" were better educated, had lower lifetime rates of exposure, and gave birth to newborns with higher birth weights (3254.7±506.9 g vs. 2650.8±785.6 g for the study group).

Conclusion: Compliance of the exposed women to BI was high and contributed to exposure reduction during pregnancy but relapsed following delivery.

Background: We aimed to identify characteristics and outcomes of involuntary and voluntary admissions of dual-diagnosis patients in a single, large mental health center in Israel.

Methods: Using a retrospective chart review methodology, 24 patient records were reviewed spanning a period of five years; clinical and demographic variables of voluntary and involuntary admissions were compared.

Results: No significant differences were found in sociodemographic characteristics, admission diagnosis and length of hospitalization between the two types of admission. A smaller proportion of patients discharged from involuntary admissions were in remission compared to those discharged from voluntary admission. Nevertheless, involuntary admissions were associated with longer time to next hospitalization.

Limitations: The data were based on a small number of patients in a single ward, thus the generalizability of the results is uncertain.

Conclusions: The finding of the current study that involuntary admission leads to longer tenure in the community suggests that there may be clinical advantages to involuntary admissions for certain dual diagnosis patients.