Premorbid functioning in a national population of male twins discordant for psychoses

OBJECTIVE

The goal of the current study was to compare premorbid behavioral and cognitive functioning between co-twins discordant for psychotic disorder and between these pairs of twins and pairs of twins with no psychotic disorders.

METHOD

The authors linked data from the Israeli Draft Board Registry, which contains cognitive and behavioral assessments of all 16-17-year-old male Israeli twins, with data from the National Psychiatric Hospitalization Case Registry. Pairs of male twins who were healthy at the time of testing but discordant for psychoses later on were compared with one another and with pairs of healthy male twins.

RESULTS

The affected twins performed significantly worse than healthy twins on measures of individual autonomy, social functioning, and physical activity and nonsignificantly worse on measures of abstract reasoning. There were no significant differences in cognitive or behavioral scores between the co-twins who did or did not develop psychotic disorders.

CONCLUSIONS

The authors conclude that these findings underscore the familial nature of behavioral and cognitive deficits antecedent to psychoses.

[Late postoperative colonic stenosis caused by the biofragmentable anastomosis ring (BAR)]

The authors focused their attention on the prevalence of late postoperative stenoses of anastomoses following resection of the colon. In 42 patients the anastomosis was implemented by means of a Valtrac ring--i.e. by compressive biofragmentable seamless technique. Within an interval of 6 months after surgery the majority of these patients were subjected to colonoscopic examination with direct visualization of the intestinal anastomosis. The authors did not record any late postoperative stenoses of the BAR anastomosis of the colon. Moreover on colonoscopic examination in the majority of patients the original intestinal anastomosis was only difficult to detect.

Cognitive and behavioural functioning in men with schizophrenia both before and shortly after first admission to hospital. Cross-sectional analysis

BACKGROUND

The extent of premorbid changes associated with the onset of schizophrenia are debated.

AIMS

The study examined cognitive and behavioural functioning prior to, and after, first hospitalisation for schizophrenia.

METHOD

Data from the Israeli Draft Board Register of intelligence, social functioning and behaviour testing for all Israeli males aged 16-17 was linked with data from the National Psychiatric Hospitalisation Case Register. This identified 692 men who had been admitted to hospital for schizophrenia. Cases and non-cases matched on age and school were compared, as were cases aggregated by the time that had elapsed between testing and first admission to hospital.

RESULTS

Cases performed worse than non-cases on all measures. On Social Functioning and on Raven's Progressive Matrices-R, differences between cases and non-cases were progressively greater for cases admitted closer to the time of testing. These differences were greatest for persons tested after first psychiatric hospitalisation.

CONCLUSIONS

The results confirm premorbid deficits associated with schizophrenia and support the hypothesis that decline is progressive.

Normalization of heart rate variability in post-traumatic stress disorder patients following fluoxetine treatment: preliminary results

BACKGROUND

Spectral analysis of heart rate variability has been shown to be a reliable non-invasive test for quantitative assessment of cardiovascular autonomic regulatory responses, providing a window reflecting the interaction of sympathetic and parasympathetic tone. Alterations in autonomic function are associated with a variety of physiologic and pathophysiologic processes and may contribute substantially to morbidity and mortality. Our previous study shows that patients with post-traumatic stress disorder have significantly lower HRV compared to controls, reflecting a basal autonomic state characterized by increased sympathetic and decreased parasympathetic tone.

OBJECTIVES

To apply this tool to PTSD patients treated with selective serotonin re-uptake inhibitors in order to assess the impact of such treatment on the autonomic dysregulation characterizing these patients.

METHODS

Standardized heart rate analysis was carried out in nine PTSD patients treated with SSRI agents and compared to that in a matched control group of nine healthy volunteers and in nine untreated PTSD patients, based on a 15 minute resting electrocardiogram.

RESULTS

Our preliminary results show that the HRV parameters indicating autonomic dysregulation, which characterize PTSD patients at rest, are normalized in responding patients by use of SSRIs. Neither the clinical implications of these findings nor their physiological mechanisms are clear at present, although we presume that they reflect a central effect, since the peripheral autonomic effects of SSRIs are relatively negligible.

[Compression anastomosis in acute resection of the colon]

The authors draw attention to the possible use of a biofragmentable anastomotic ring (BAR) for anastomosis of the gut, used by the authors for construction of an anastomosis after acute resection of the colon under particularly risky conditions with infection and advanced deterioration of the intestinal wall. In both instances when this alternative method was used the postoperative course was uneventful and the patients were discharged without complications into domiciliary treatment.

Behavioral and intellectual markers for schizophrenia in apparently healthy male adolescents

OBJECTIVE

Subtle behavioral and intellectual abnormalities are often present in apparently healthy adolescents who later develop schizophrenia. The authors investigated whether these abnormalities can predict vulnerability for schizophrenia before the first psychotic manifestation.

METHOD

The study consisted of linking the Israeli Draft Board Registry with the National Psychiatric Hospitalization Case Registry. The draft board tests measure intelligence, social functioning, organizational ability, interest in physical activity, and individual autonomy. Patients (N = 509) were compared to nonpatients, i.e., adolescents not appearing in the National Psychiatric Registry (N = 9,215), matched to patients by age, gender, and school attended at time of testing.

RESULTS

Healthy male adolescents who were later hospitalized for schizophrenia had significantly lower test scores on all measures than adolescents not reported to the National Psychiatric Registry. The strongest predictors for schizophrenia were deficits in social functioning, organizational ability, and intellectual functioning. When patients were compared to matched nonpatients, the prediction model had a 75% sensitivity, a 100% specificity, a positive predictive value of 72%, and an overall rate of correct classification of 87.5%. Applied to the Israeli Draft Board Registry, the model yielded a sensitivity of 74.7%, a validated specificity of 99.7%, and a positive predictive value of 42.7%.

CONCLUSIONS

This study demonstrated that simple assessment tools can predict predisposition to schizophrenia in healthy male adolescents. The model's predictive ability does not change as a function of the time elapsed between testing and first hospitalization. This suggests that the model identifies apparently healthy individuals who will manifest the disease later who are not prodromal to psychosis. Easily applied tools allowing early identification of schizophrenia or vulnerability to it may enable early intervention.

The goals and limitations of Israel's psychiatric case register

The Israeli Ministry of Health maintains a psychiatric case register that includes basic demographic and clinical information for all psychiatric hospital admissions since 1950. Currently, the case register includes information about some 130,000 people who have been hospitalized. The case register is an important tool in many aspects of mental health care planning, such as delineating problem populations, developing interventions, assessing the ramifications of policies, enacting programs for quality control, and conducting research. In certain situations stipulated by law, some information in the case register is shared with other authorities. Although the full potential of the psychiatric case register has not been exploited so far, creation of additional linkages with other databases and increased application of case register data in field studies could enhance its usefulness.

Stress and intervention strategies in mental health professionals

There is growing evidence to show that mental health professionals by the nature of their work are particularly vulnerable to stress with all its detrimental effects on service delivery and quality of care. This comes at a time when mental health services in many countries are under considerable strain. The present paper examines the multifaceted stressors encountered by the mental health team and recommends possible ways of reducing burnout through innovative intervention strategies. The detection of emotional distress and psychological dysfunctioning in mental health providers is outlined and their management carefully considered.

[Continuous loop stitch in single-layer laparotomy suturing]

The authors evaluate their favourable experience with the use of a new absorbable loop suture for one-layer closure laparotomy. The percentage of dehiscences of surgical wounds was lower in the group of patients where Safil Loop suture was used than in the control group. The speed of completing the suture was also greater and the safety of closure of laparotomy was more favourable.

Power spectral analysis of heart rate variability in psychiatry

Power spectrum analysis of heart rate variability (PSA of HRV) is a promising method, which can be used as an index of cardiac autonomic balance. PSA of HRV is a noninvasive technique, based on ECG sampling of RR interval variation, thus providing a dynamic assessment of sympathetic and parasympathetic tone, reflecting the interactions between the two. It has been shown to have potential value in various laboratory and clinical conditions. It is influenced by many factors such as age, sex, position, breathing, smoking, hour of the day and medications. Different methods of data processing by various authors have often elicited conflicting results. Standard values are not yet available to be used or compared in different settings. From the interest it has raised, it may be expected that this method will be in widespread use in clinical practice in the future, providing a useful tool, both for diagnostic and prognostic purposes, as well as serving as a further aid towards monitoring therapeutic interventions. This review highlights techniques of dynamic assessment of HRV and studies of its clinical applications in psychiatry in particular. It raises the potentially important prognostic implications of protracted autonomic dysfunction in psychiatric patient populations, especially for cardiovascular morbidity and mortality.

Suicide risk and coping styles in posttraumatic stress disorder patients

BACKGROUND

Suicide and suicidal behavior have been found to be increased among posttraumatic stress disorder (PTSD) patients. The present study examined suicide risk and Plutchik's coping styles in PTSD patients.

METHOD

47 PTSD patients were compared with 42 patients with mixed non-PTSD anxiety disorders and 50 healthy control subjects, matched for age and gender, on a measure of suicide risk.

RESULTS

The PTSD patients scored significantly higher than the two control groups on the suicide risk measure. Furthermore, in the PTSD group, suicide risk was significantly negatively correlated with the coping mechanisms of mapping, minimization and replacement and positively correlated with the coping style of suppression. Furthermore, the coping styles significantly explained the variance of the suicide risk measure for all three groups.

CONCLUSIONS

The cognitive map of PTSD patients highly resembles other populations with high suicide risk. Clinicians treating victims of traumatic events should focus on problem-solving therapies in order to help these patients deal less rigidly with everyday stresses and by this decrease the suicide risk.

Validity study of the EDI-2 in Israeli population

This study was designed to validate the EDI-2 (1) in an Israeli population. The sample consisted of 29 anorectic patients and 18 recovering anorectics, recruited from six hospitals, and 67 female control subjects matched by age. Results of the validity study indicate that the translated EDI-2 was reliable and valid. Anorectic patients scored higher than the recovering anorectics on most scales. Recovering anorectics resembled the control subjects on most scales except Perfectionism.

Analysis of heart rate variability in posttraumatic stress disorder patients in response to a trauma-related reminder

BACKGROUND

Spectral analysis of heart rate variability has recently been shown to be a reliable noninvasive test for quantitative assessment of cardiovascular autonomic regulatory responses, providing a dynamic map of sympathetic and parasympathetic interaction. In a prior study exploring the state of hyperarousal characterizing the posttraumatic stress disorder (PTSD) syndrome, the authors described standardized heart rate analysis carried out in 9 PTSD patients at rest, which demonstrated clear-cut evidence of a baseline autonomic hyperarousal state.

METHODS

To examine the dynamics of this hyperarousal state, standardized heart rate analysis was carried out in 9 PTSD patients compared to a matched control group of 9 healthy volunteers. Twenty-minute recordings of electrocardiogram in response to a trauma-related cue as opposed to a resting state were performed and analyzed. The PTSD patients were asked to recount the presumed triggering traumatic event, and the control subjects recounted a significant stressful negative life event.

RESULTS

Our results show that, whereas the control subjects demonstrated significant autonomic responses to the stressogenic stimulus supplied by the recounting of a major stressful experience, the PTSD patients demonstrated almost no autonomic response to the recounting of the triggering stressful event. The PTSD patients demonstrated a degree of autonomic dysregulation at rest which was comparable to that seen in the control subjects' reaction to the stress model.

CONCLUSIONS

The lack of response to the stress model applied in the study appears to imply that PTSD patients experience so great a degree of autonomic hyperactivation at rest, that they are unable to marshal a further stress response to the recounting of the triggering trauma, as compared to control subjects.

Disadvantages of local repair in acute type A aortic dissection

BACKGROUND

In acute type A dissection of the aorta, local repair with glue-aortoplasty was compared with aortic replacement.

METHODS

Between 1992 and 1996, 106 consecutive patients (mean age, 59 years; 84 men) were operated on average 14.5 hours after onset of dissection. A local repair (gelatin-resorcine-formaldehyde/glutaraldehyde glue, Trigon AG, Monchengladbach, Germany) without graft replacement was performed in 21 patients. Graft replacement and reinforcement of aortic stumps with gelatin-resorcine-formaldehyde/glutaraldehyde glue was performed in 85 patients (supracoronary graft, 68; aortic root replacement, 17).

RESULTS

Survival was 79% after 30 days and 69% after 2 years. There was no difference in early mortality (p = 0.2240) and survival (p = 0.07649). Risk factors for early mortality were preoperative shock, neurologic disorder, duration of crossclamp, and extracorporeal circulation. The rate of reoperation on the proximal aorta was 31.6% (6 of 19) after local repair and 9% (6 of 64) after aortic replacement (p = 0.0157). Local repair was a significant predictor for reoperation (p = 0.0087), with decreased reoperation-free survival (p = 0.01164). In all reinterventions (four supracoronary grafts, including two valve replacements; two composite grafts; two arch replacements) breakdown of the aortoplasty was confirmed.

CONCLUSION

Local repair has satisfactory early results but an increased incidence of reoperations due to a breakdown of the glue-aortoplasty. Indications for local repair should be restricted to high-risk patients requiring a minimal emergency surgical procedure.

Inhibition of anxiety in rats by antisense to cholecystokinin precursor protein

BACKGROUND

Cholecystokinin (CCK) and its analogs generates anxiety in humans and measurable anxiety-like behaviors in rats. CCK receptor blockers have had mixed results as a treatment approach for anxiety disorders. Since CCK is a peptide, we explored another strategy to reduce CCK levels in brain by antisense oligodeoxynucleotide inhibition of DNA transcription or messenger RNA (mRNA) translation for CCK precursor protein.

METHODS

Antisense oligodeoxynucleotide complementary to the start coding region of rat CCK-precursor was intracerebroventricularly (icv) infused into rats three times at 24-hour intervals. Control groups received infusions of either a scramble sequence oligodeoxynucleotide or vehicle. On the fourth day, rats were assessed in the elevated plus maze paradigm.

RESULTS

Compared to vehicle and scramble sequence oligodeoxynucleotide control, icv CCK-antisense exogenous administration for 3 days significantly diminished anxiety behavior in rats.

CONCLUSIONS

Antisense inhibition of CCK-mediated anxiety could have therapeutic potential in human anxiety disorders.

Debriefing with brief group psychotherapy in a homogenous group of non-injured victims of a terrorist attack: a prospective study

This study describes a follow-up of 15 non-injured women, all from the same socio-economic background, who were exposed to a terrorist attack in Israel. All of the women participated in group debriefing with brief group psychotherapy, involving six meetings during the first 2 months following the event. Two days after the attack, and 2 months and 6 months after the event, the women were administered a post-traumatic stress disorder (PTSD) diagnostic scale, the Impact of Event Scale (IES) and the SCL-90. At 6 months, four subjects (27%) were diagnosed with full PTSD. The IES showed significantly higher scores at the first measure than at the other two measures. Furthermore, the phobic anxiety subscale score immediately after the event was significantly associated with the General Severity Index of the SCL-90 and the severity of PTSD symptomatology at 6 months. The present paper discusses the effectiveness of psychological intervention following trauma, and raises questions concerning the need to invest public resources in this kind of intensive intervention. Suggestions are proposed regarding the desired emphasis of the psychological treatment in order to improve its benefits to victims.

Effect of transcranial magnetic stimulation in posttraumatic stress disorder: a preliminary study

BACKGROUND

Transcranial magnetic stimulation (TMS) has become, over the last few years, a promising avenue for new research in affective disorders. In this study we have evaluated the clinical effect of slow TMS on posttraumatic stress disorder (PTSD) symptoms.

METHODS

Ten PTSD patients were given one session of slow TMS with 30 pulses of 1 m/sec each, 15 to each side of the motor cortex.

RESULTS

Symptoms of PTSD were assessed by using three psychological assessment scales, at four different time points. In this first, pilot, open study, TMS was found to be effective in lowering the core symptoms of PTSD: avoidance (as measured by the Impact of Event Scale), anxiety, and somatization (as measured by the Symptom Check List-90). A general clinical improvement was found (as measured by the Clinical Global Impression scale); however, the effect was rather short and transient.

CONCLUSIONS

The present study showed TMS to be a safe and tolerable intervention with possibly indications of therapeutic efficacy for PTSD patients.

[Laparoscopy in oncology patients]

In a group of 23 patients with suspected malignant disease in the abdominal cavity laparoscopy was indicated and 11 times positive findings were obtained--six time a primary tumourous process and five times secondaries. The authors demonstrate on case-histories the advantages of laparoscopy when other examination fail or give dubious results. In their group of patients it always helped to establish a definite diagnosis.

Posttraumatic stress disorder, tenderness and fibromyalgia

The aims of the present study were to inquire into the prevalence of fibromyalgia syndrome, to assess nonarticular tenderness, to measure fibromyalgia syndrome-related symptoms, quality of life, and functional impairment among posttraumatic stress disorder (PTSD) patients as compared with control subjects. Furthermore, the differences between the PTSD patients with and without fibromyalgia syndrome were studied. Twenty-nine PTSD patients and 37 control subjects were assessed as to the diagnosis of fibromyalgia syndrome according to the American College of Rheumatology. Tenderness was assessed manually and with a dolorimeter. Fibromyalgia syndrome-related symptoms, quality of life, physical functioning, PTSD symptomatology, and psychiatric features were assessed by valid and reliable self-report inventories. Results showed that the prevalence of fibromyalgia syndrome in the PTSD group was 21% vs. 0% in the control group. Furthermore, the PTSD group was more tender than the control group. PTSD subjects suffering from fibromyalgia syndrome were more tender, reported more pain, lower quality of life, higher functional impairment and suffered more psychological distress than the PTSD patients not having fibromyalgia syndrome. It is suggested that previous reports on diffuse pain in PTSD in fact described undiagnosed fibromyalgia syndrome. The link between psychological stress and pain syndromes is emphasized.

Inositol has behavioral effects with adaptation after chronic administration

Inositol is a simple dietary polyol that serves as a precursor in important second messenger systems. Inositol in pharmacological doses has been reported recently to be therapeutic in depression, panic disorder and obsessive compulsive disorder. We hereby report effects of inositol on the elevated plus maze model of anxiety. These results should allow development of new inositol analogs that could expand psychoactive drug development possibilities via second messenger manipulation.