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Weiser M, Levi L, Park J, Nastas I, Matei V, Davidson M, Arad I, Dudkiewicz I, Davis JM. A randomized controlled trial of add-on naproxen, simvastatin and their combination for the treatment of schizophrenia or schizoaffective disorder. Eur Neuropsychopharmacol 2023; 73:65-74. [PMID: 37126871 DOI: 10.1016/j.euroneuro.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/31/2023] [Accepted: 04/04/2023] [Indexed: 05/03/2023]
Abstract
This large randomized controlled trial examined the effect of naproxen, simvastatin or both on patients with schizophrenia. This was a large multi-center, twelve-week, randomized, double-blind, placebo-controlled, four-arm clinical trial administering naproxen, simvastatin or both to 232 subjects with schizophrenia or schizoaffective disorder. The primary outcome was change in PANSS total score. ANCOVA and mixed model analyses of the PANSS total score change showed no significant difference between naproxen and placebo (adjusted p = 0.78), simvastatin and placebo (adjusted p = 0.38) or the combination of naproxen and simvastatin compared to placebo (adjusted p = 0.72). No statistically significant drug-placebo differences were found in the PANSS subscales, CGI or BACS between all groups. There was a near significant improvement in negative symptoms (p = 0.06), and an analysis of the 5 factor PANSS factors analysis found a significant improvement in simvastatin above placebo in withdrawal (p = 0.03). These finding were not significant after correcting for multiple comparisons. A meta-analysis on changes in total PANSS scores in studies on statins in schizophrenia, including the present study together with six other studies showed a significant improvement for statins compared to placebo (Hedges' G of -0.245 (CI= -0.403, -0.086, p = 0.002). When one outlying study which showed particularly strong effects of statins was removed, part of the effect went away. In conclusion, in this study, naproxen and simvastatin alone or in combination were not efficacious in the treatment of symptoms in schizophrenia. However, the meta-analysis of all studies of simvastatin for schizophrenia indicates further research on this topic.
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Affiliation(s)
- Mark Weiser
- Sheba Medical Center, Tel Hashomer 52621, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Linda Levi
- Sheba Medical Center, Tel Hashomer 52621, Israel
| | - Jinyoung Park
- Department of Psychology and Neuroscience, Duke University, USA
| | - Igor Nastas
- Department of Psychiatry, Narcology and Medical Psychology, State University of Medicine and Pharmacy Nicolae Testemitanu, Chișinău, Moldova
| | - Valentin Matei
- Department of Neuroscience, discipline of Psychiatry, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | | | - Ido Arad
- Sheba Medical Center, Tel Hashomer 52621, Israel
| | - Israel Dudkiewicz
- Sheba Medical Center, Tel Hashomer 52621, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - John M Davis
- Department of Psychiatry, University of Illinois, Chicago, IL 60607, USA
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Levi L, Bar-Haim M, Winter-van Rossum I, Davidson M, Leucht S, Fleischhacker WW, Park J, Davis JM, Kahn RS, Weiser M. Cannabis Use and Symptomatic Relapse in First Episode Schizophrenia: Trigger or Consequence? Data From the OPTIMISE Study. Schizophr Bull 2023; 49:903-913. [PMID: 36999551 PMCID: PMC10318873 DOI: 10.1093/schbul/sbad033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
BACKGROUND AND HYPOTHESIS This analysis examined the relationship between cannabis use, compliance with antipsychotics and risk for relapse in patients in remission following a first episode of schizophrenia, schizophreniform, or schizoaffective disorder. STUDY DESIGN Analyses were performed on data from a large European study on first episode of schizophrenia, schizophreniform, or schizoaffective disorder (OPTiMiSE). After 10 weeks of antipsychotic treatment, 282/446 patients (63%) met criteria for symptomatic remission; of whom 134/282 (47.5%) then completed a 1-year follow-up. Cross-lagged models and mediation models investigated the temporal relationships between cannabis use, compliance with antipsychotics, social functioning, and symptomatic worsening/relapse. STUDY RESULTS Compared to nonusers, cannabis use increased risk for relapse, adjusted hazard ratio (HR) = 3.03 (SE = 0.32), P < .001, even in patients who were compliant with antipsychotic medication, adjusted HR = 2.89, (SE = 0.32), P < .001. Cannabis use preceded symptomatic worsening and was followed by worsening of Positive and Negative Syndrome Scale total score at the 1-year end-point (standardized β = 0.62, SE = 0.19, P = .001) and by worsening of social functioning (coef = -0.66, P ≤ .001). CONCLUSIONS In patients in remission from their first episode of schizophrenia, schizophreniform, or schizoaffective disorder, cannabis use increases the rate of relapse in both compliant and noncompliant individuals. Importantly, the temporal relationship between cannabis and relapse was that cannabis use preceded later relapse, noncompliance, and decrease in social functioning, and not that patients began to relapse, then used cannabis. Further research with a precision psychiatry approach might identify those patients in particular danger of relapse when using cannabis.
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Affiliation(s)
- Linda Levi
- Psychiatry Department, Sheba Medical Center, Ramat Gan, Israel
| | - Mor Bar-Haim
- Psychiatry Department, Sheba Medical Center, Ramat Gan, Israel
| | - Inge Winter-van Rossum
- Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | | | - Stefan Leucht
- Psychiatry Department, Technical University of Munich, Munich, Germany
| | | | - Jinyoung Park
- Department of Psychology and Neuroscience, Duke University, Durham, NC
| | - John M Davis
- Department of Psychiatry, University of Illinois, Chicago, IL
| | - Renè S Kahn
- Department of Psychiatry, Icahn School of Medicine, Mount Sinai, NY
| | - Mark Weiser
- Psychiatry Department, Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Weiser M, Frenkel O, Fenchel D, Tzur D, Sandin S, Janecka M, Levi L, Davidson M, Laor L, Fruchter E, Reichenberg A. Familial clustering of psychiatric disorders and low IQ. Psychol Med 2023; 53:2878-2884. [PMID: 34911593 DOI: 10.1017/s0033291721004852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Although the ICD and DSM differentiate between different psychiatric disorders, these often share symptoms, risk factors, and treatments. This was a population-based, case-control, sibling study examining familial clustering of all psychiatric disorders and low IQ, using data from the Israel Draft-Board Registry on all Jewish adolescents assessed between 1998 and 2014. METHODS We identified all cases with autism spectrum disorder (ASD, N = 2128), severe intellectual disability (ID, N = 9572), attention-deficit hyperactive disorder (ADHD) (N = 3272), psychotic (N = 7902), mood (N = 9704), anxiety (N = 10 606), personality (N = 24 816), or substance/alcohol abuse (N = 791) disorders, and low IQ (⩾2 SDs below the population mean, N = 31 186). Non-CNS control disorders were adolescents with Type-1 diabetes (N = 2427), hernia (N = 29 558) or hematological malignancies (N = 931). Each case was matched with 10 age-matched controls selected at random from the Draft-Board Registry, with replacement, and for each case and matched controls, we ascertained all full siblings. The main outcome measure was the relative recurrence risk (RRR) of the sibling of a case having the same (within-disorder RRR) or a different (across-disorder RRR) disorder. RESULTS Within-disorder RRRs were increased for all diagnostic categories, ranging from 11.53 [95% confidence interval (CI): 9.23-14.40] for ASD to 2.93 (95% CI: 2.80-3.07) for personality disorders. The median across-disorder RRR between any pair of psychiatric disorders was 2.16 (95% CI: 1.45-2.43); the median RRR between low IQ and any psychiatric disorder was 1.37 (95% CI: 0.93-1.98). There was no consistent increase in across-disorder RRRs between the non-CNS disorders and psychiatric disorders and/or low IQ. CONCLUSION These large population-based study findings suggest shared etiologies among most psychiatric disorders, and low IQ.
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Affiliation(s)
- Mark Weiser
- Department of Psychiatry, Chaim Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Or Frenkel
- Department of Psychiatry, Chaim Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
| | - Daphna Fenchel
- Department of Psychiatry, Chaim Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
| | - Dorit Tzur
- Medical Corps, Israel Defense Force, Israel
| | - Sven Sandin
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Magdalena Janecka
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Linda Levi
- Department of Psychiatry, Chaim Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
| | | | | | - Eyal Fruchter
- Medical Corps, Israel Defense Force, Israel
- Department of Psychiatry, Rambam Medical Center, Haifa, Israel
- Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Abraham Reichenberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Levi L, Zamora D, Nastas I, Gonen I, Radu P, Matei V, Ciobanu AM, Nacu A, Boronin L, Karakrah L, Davidson M, Davis JM, Weiser M. Add-On Pramipexole for the Treatment of Schizophrenia and Schizoaffective Disorder: A Randomized Controlled Trial. J Clin Psychiatry 2022; 83. [PMID: 35921506 DOI: 10.4088/jcp.21m14233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Objective: Several small clinical trials have reported that the dopamine agonist pramipexole was beneficial in treating patients with schizophrenia. A confirmatory trial was conducted to test this hypothesis. Methods: This 16-week, multicenter, double-blind, randomized, placebo-controlled study included 200 subjects meeting DSM-IV-TR criteria for schizophrenia or schizoaffective disorder. Patients were randomized to receive either pramipexole (0.75 mg twice daily, n = 100) or placebo (n = 100) as an add-on to their regular antipsychotic treatment. The primary outcome measure was the total score on the Positive and Negative Syndrome Scale (PANSS); secondary outcome measures included PANSS subscale and cognitive functioning scores. Recruitment was performed in 30 sites in Romania and 1 site in the Republic of Moldova between January and June 2011. Results: Analysis of covariance models showed no significant difference between pramipexole and placebo for total PANSS (P > .99) and PANSS positive (P > .99), negative (P = .73), and general psychopathology (P = .99) subscale scores. Changes in Clinical Global Impressions-Severity of Illness scale and Brief Assessment of Cognition in Schizophrenia scores showed no significant difference between pramipexole and placebo. Conclusions: The results of this large randomized controlled trial indicated that pramipexole was not efficacious as an add-on to antipsychotic medications for schizophrenia. Trial Registration: ClinicalTrials.gov identifier NCT01320982.
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Affiliation(s)
- Linda Levi
- Department of Psychiatry, Sheba Medical Center, Tel Hashomer, Israel
| | - Daisy Zamora
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina
| | - Igor Nastas
- Department of Psychiatry, Narcology and Medical Psychology, State University of Medicine and Pharmacy Nicolae Testemitanu, Chișinău, Moldova
| | | | | | - Valentin Matei
- Department of Neuroscience, Discipline of Psychiatry, University of Medicine and Pharmacy "Carol Davila," Bucharest, Romania
| | - Adela M Ciobanu
- Department of Neuroscience, Discipline of Psychiatry, University of Medicine and Pharmacy "Carol Davila," Bucharest, Romania
| | - Anatol Nacu
- Department of Psychiatry, Narcology and Medical Psychology, State University of Medicine and Pharmacy Nicolae Testemitanu, Chișinău, Moldova
| | - Larisa Boronin
- Department of Psychiatry, Narcology and Medical Psychology, State University of Medicine and Pharmacy Nicolae Testemitanu, Chișinău, Moldova
| | - Lusian Karakrah
- Department of Psychiatry, Sheba Medical Center, Tel Hashomer, Israel
| | | | - John M Davis
- Department of Psychiatry, University of Illinois, Chicago, Illinois
| | - Mark Weiser
- Department of Psychiatry, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Corresponding author: Mark Weiser. MD, Department of Psychiatry, Sheba Medical Center, Tel-Hashomer, 52621, Israel
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Weiser M, Davis JM, Brown CH, Slade EP, Fang LJ, Medoff DR, Buchanan RW, Levi L, Davidson M, Kreyenbuhl J. Differences in Antipsychotic Treatment Discontinuation Among Veterans With Schizophrenia in the U.S. Department of Veterans Affairs. Am J Psychiatry 2021; 178:932-940. [PMID: 34256606 DOI: 10.1176/appi.ajp.2020.20111657] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Effectiveness of antipsychotic drugs is inferred from relatively small randomized clinical trials conducted with carefully selected and monitored participants. This evidence is not necessarily generalizable to individuals treated in daily clinical practice. The authors compared the clinical effectiveness between all oral and long-acting injectable (LAI) antipsychotic medications used in the treatment of schizophrenia in the U.S. Department of Veterans Affairs (VA) health care system. METHODS This was an observational study utilizing VA pharmacy data from 37,368 outpatient veterans with schizophrenia. Outcome measures were all-cause antipsychotic discontinuation and psychiatric hospitalizations. Oral olanzapine was used as the reference group. RESULTS In multivariable analysis, clozapine (hazard ratio=0.43), aripiprazole long-acting injectable (LAI) (hazard ratio=0.71), paliperidone LAI (hazard ratio=0.76), antipsychotic polypharmacy (hazard ratio=0.77), and risperidone LAI (hazard ratio=0.91) were associated with reduced hazard of discontinuation compared with oral olanzapine. Oral first-generation antipsychotics (hazard ratio=1.16), oral risperidone (hazard ratio=1.15), oral aripiprazole (hazard ratio=1.14), oral ziprasidone (hazard ratio=1.13), and oral quetiapine (hazard ratio=1.11) were significantly associated with an increased risk of discontinuation compared with oral olanzapine. No treatment showed reduced risk of psychiatric hospitalization compared with oral olanzapine; quetiapine was associated with a 36% worse outcome in terms of hospitalizations compared with olanzapine. CONCLUSIONS In a national sample of veterans with schizophrenia, those treated with clozapine, two of the LAI second-generation antipsychotics, and antipsychotic polypharmacy continued the same antipsychotic therapy for a longer period of time compared with the reference drug. This may reflect greater overall acceptability of these medications in clinical practice.
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Affiliation(s)
- Mark Weiser
- Stanley Medical Research Institute, Kensington, Md. (Weiser); Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel (Weiser, Levi); Department of Psychiatry, Tel Aviv University, Ramat Aviv, Israel (Weiser); Department of Psychiatry, University of Illinois, Chicago (Davis); VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore (Brown, Medoff, Kreyenbuhl); Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore (Brown; Medoff, Kreyenbuhl); Johns Hopkins School of Nursing, Baltimore (Slade); Department of Psychiatry, Division of Psychiatric Services Research, University of Maryland School of Medicine, Baltimore (Fang); Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore (Buchanan); and University of Nicosia Medical School, Nicosia, Cyprus (Davison)
| | - John M Davis
- Stanley Medical Research Institute, Kensington, Md. (Weiser); Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel (Weiser, Levi); Department of Psychiatry, Tel Aviv University, Ramat Aviv, Israel (Weiser); Department of Psychiatry, University of Illinois, Chicago (Davis); VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore (Brown, Medoff, Kreyenbuhl); Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore (Brown; Medoff, Kreyenbuhl); Johns Hopkins School of Nursing, Baltimore (Slade); Department of Psychiatry, Division of Psychiatric Services Research, University of Maryland School of Medicine, Baltimore (Fang); Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore (Buchanan); and University of Nicosia Medical School, Nicosia, Cyprus (Davison)
| | - Clayton H Brown
- Stanley Medical Research Institute, Kensington, Md. (Weiser); Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel (Weiser, Levi); Department of Psychiatry, Tel Aviv University, Ramat Aviv, Israel (Weiser); Department of Psychiatry, University of Illinois, Chicago (Davis); VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore (Brown, Medoff, Kreyenbuhl); Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore (Brown; Medoff, Kreyenbuhl); Johns Hopkins School of Nursing, Baltimore (Slade); Department of Psychiatry, Division of Psychiatric Services Research, University of Maryland School of Medicine, Baltimore (Fang); Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore (Buchanan); and University of Nicosia Medical School, Nicosia, Cyprus (Davison)
| | - Eric P Slade
- Stanley Medical Research Institute, Kensington, Md. (Weiser); Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel (Weiser, Levi); Department of Psychiatry, Tel Aviv University, Ramat Aviv, Israel (Weiser); Department of Psychiatry, University of Illinois, Chicago (Davis); VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore (Brown, Medoff, Kreyenbuhl); Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore (Brown; Medoff, Kreyenbuhl); Johns Hopkins School of Nursing, Baltimore (Slade); Department of Psychiatry, Division of Psychiatric Services Research, University of Maryland School of Medicine, Baltimore (Fang); Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore (Buchanan); and University of Nicosia Medical School, Nicosia, Cyprus (Davison)
| | - Li Juan Fang
- Stanley Medical Research Institute, Kensington, Md. (Weiser); Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel (Weiser, Levi); Department of Psychiatry, Tel Aviv University, Ramat Aviv, Israel (Weiser); Department of Psychiatry, University of Illinois, Chicago (Davis); VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore (Brown, Medoff, Kreyenbuhl); Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore (Brown; Medoff, Kreyenbuhl); Johns Hopkins School of Nursing, Baltimore (Slade); Department of Psychiatry, Division of Psychiatric Services Research, University of Maryland School of Medicine, Baltimore (Fang); Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore (Buchanan); and University of Nicosia Medical School, Nicosia, Cyprus (Davison)
| | - Deborah R Medoff
- Stanley Medical Research Institute, Kensington, Md. (Weiser); Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel (Weiser, Levi); Department of Psychiatry, Tel Aviv University, Ramat Aviv, Israel (Weiser); Department of Psychiatry, University of Illinois, Chicago (Davis); VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore (Brown, Medoff, Kreyenbuhl); Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore (Brown; Medoff, Kreyenbuhl); Johns Hopkins School of Nursing, Baltimore (Slade); Department of Psychiatry, Division of Psychiatric Services Research, University of Maryland School of Medicine, Baltimore (Fang); Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore (Buchanan); and University of Nicosia Medical School, Nicosia, Cyprus (Davison)
| | - Robert W Buchanan
- Stanley Medical Research Institute, Kensington, Md. (Weiser); Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel (Weiser, Levi); Department of Psychiatry, Tel Aviv University, Ramat Aviv, Israel (Weiser); Department of Psychiatry, University of Illinois, Chicago (Davis); VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore (Brown, Medoff, Kreyenbuhl); Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore (Brown; Medoff, Kreyenbuhl); Johns Hopkins School of Nursing, Baltimore (Slade); Department of Psychiatry, Division of Psychiatric Services Research, University of Maryland School of Medicine, Baltimore (Fang); Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore (Buchanan); and University of Nicosia Medical School, Nicosia, Cyprus (Davison)
| | - Linda Levi
- Stanley Medical Research Institute, Kensington, Md. (Weiser); Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel (Weiser, Levi); Department of Psychiatry, Tel Aviv University, Ramat Aviv, Israel (Weiser); Department of Psychiatry, University of Illinois, Chicago (Davis); VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore (Brown, Medoff, Kreyenbuhl); Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore (Brown; Medoff, Kreyenbuhl); Johns Hopkins School of Nursing, Baltimore (Slade); Department of Psychiatry, Division of Psychiatric Services Research, University of Maryland School of Medicine, Baltimore (Fang); Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore (Buchanan); and University of Nicosia Medical School, Nicosia, Cyprus (Davison)
| | - Michael Davidson
- Stanley Medical Research Institute, Kensington, Md. (Weiser); Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel (Weiser, Levi); Department of Psychiatry, Tel Aviv University, Ramat Aviv, Israel (Weiser); Department of Psychiatry, University of Illinois, Chicago (Davis); VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore (Brown, Medoff, Kreyenbuhl); Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore (Brown; Medoff, Kreyenbuhl); Johns Hopkins School of Nursing, Baltimore (Slade); Department of Psychiatry, Division of Psychiatric Services Research, University of Maryland School of Medicine, Baltimore (Fang); Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore (Buchanan); and University of Nicosia Medical School, Nicosia, Cyprus (Davison)
| | - Julie Kreyenbuhl
- Stanley Medical Research Institute, Kensington, Md. (Weiser); Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel (Weiser, Levi); Department of Psychiatry, Tel Aviv University, Ramat Aviv, Israel (Weiser); Department of Psychiatry, University of Illinois, Chicago (Davis); VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore (Brown, Medoff, Kreyenbuhl); Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore (Brown; Medoff, Kreyenbuhl); Johns Hopkins School of Nursing, Baltimore (Slade); Department of Psychiatry, Division of Psychiatric Services Research, University of Maryland School of Medicine, Baltimore (Fang); Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore (Buchanan); and University of Nicosia Medical School, Nicosia, Cyprus (Davison)
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Davidson M, Levi L, Park J, Nastas I, Ford L, Rassnick S, Canuso C, Davis JM, Weiser M. The effects of JNJ-39393406 a positive allosteric nicotine modulator on mood and cognition in patients with unipolar depression: A double-blind, add-on, placebo-controlled trial. Eur Neuropsychopharmacol 2021; 51:33-42. [PMID: 34023797 DOI: 10.1016/j.euroneuro.2021.04.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/27/2021] [Accepted: 04/29/2021] [Indexed: 12/23/2022]
Abstract
Nicotinic agonists have been shown to improve cognition and mood, but this improvement is inconsistent and short-lived, possibly due to receptor desensitization. Positive Allosteric Modulators (PAMs) of the nicotinic alpha-7 nicotinic-acetyl-choline receptor (a7nAChR) are hypothesized to change the configuration of the nicotinic receptor and delay desensitization, potentially increasing the duration of the activation of the receptor, and improving clinical efficacy. This was a randomized controlled trial (RCT) adding JNJ-39393406 9 (a PAM of the a7nAChR) (n=35) or placebo (n=36) to treatment as usual for two weeks in 71 patients with unipolar depression. Mixed models for repeated measures analyses were performed Primary outcome measures were the Brief Assessment of Cognition in Schizophrenia (BACS) composite and the Montgomery-Asperg Depression Rating Scale (MADRS) scores. The drug was well tolerated, however mixed models for repeated measures comparing JNJ-39393406 to placebo showed no significant difference for MADRS total score (p=0.78), BACS composite score (p=0.34), or any of the secondary outcome measures. There was no significant difference in adverse events between the study groups (p=0.44). In conclusion, this study's findings do not support the hypothesis that a positive nicotinic receptor modulator can improve cognitive or depressive symptomatology in patients with unipolar depression.
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Affiliation(s)
| | - Linda Levi
- Department of Psychiatry, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel
| | - Jinyoung Park
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Igor Nastas
- Department of Psychiatry, Narcology and Medical Psychology, State University of Medicine and Pharmacy Nicolae Testemitanu, Moldova
| | - Lisa Ford
- Janssen Research & Development LLC, USA
| | | | | | - John M Davis
- Department of Psychiatry, University of Illinois, Chicago, IL, USA
| | - Mark Weiser
- Department of Psychiatry, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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7
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Abstract
Few studies address publication and outcome reporting biases of randomized controlled trials (RCTs) in psychiatry. The objective of this study was to determine publication and outcome reporting bias in RCTs funded by the Stanley Medical Research Institute (SMRI), a U.S. based, non-profit organization funding RCTs in schizophrenia and bipolar disorder. We identified all RCTs (n = 280) funded by SMRI between 2000 and 2011, and using non-public, final study reports and published manuscripts, we classified the results as positive or negative in terms of the drug compared to placebo. Design, outcome measures and statistical methods specified in the original protocol were compared to the published manuscript. Of 280 RCTs funded by SMRI between 2000 and 2011, at the time of this writing, three RCTs were ongoing and 39 were not performed. Among the 238 completed RCTs, 86 (36.1%) reported positive and 152 (63.9%) reported negative results: 86% (74/86) of those with positive findings were published in contrast to 53% (80/152) of those with negative findings (P < .001). In 70% of the manuscripts published, there were major discrepancies between the published manuscript and the original RCT protocol (change in the primary outcome measure or statistics, change in a number of patient groups, 25% or more reduction in sample size). We conclude that publication bias and outcome reporting bias is common in papers reporting RCTs in schizophrenia and bipolar disorder. These data have major implications regarding the validity of the reports of clinical trials published in the literature.
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Affiliation(s)
- Jana Bowcut
- Stanley Medical Research Institute, Kensington, MD, USA
| | - Linda Levi
- Department of Psychiatry, Sheba Medical Center, Tel Hashomer,Israel
| | - Ortal Livnah
- Department of Psychiatry, Sheba Medical Center, Tel Hashomer,Israel
| | - Joseph S Ross
- Department of Internal Medicine, Yale University School of Medicine; Department of Health Policy and Management, Yale University School of Public Health; and the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT,USA
| | | | | | - John M Davis
- Department of Psychiatry, University of Illinois, Chicago, IL,USA
| | - Mark Weiser
- Stanley Medical Research Institute, Kensington, MD, USA,Department of Psychiatry, Sheba Medical Center, Tel Hashomer,Israel,Sackler School of Medicine, Tel Aviv University, Tel Aviv,Israel,To whom correspondence should be addressed; 10605 Concord Street, Suite 206, Kensington, MD 20895, USA; tel: 052-6666570, e-mail:
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Weiser M, Zamora D, Levi L, Nastas I, Gonen I, Radu P, Matei V, Nacu A, Boronin L, Davidson M, Davis JM. Adjunctive Aspirin vs Placebo in Patients With Schizophrenia: Results of Two Randomized Controlled Trials. Schizophr Bull 2021; 47:1077-1087. [PMID: 33479775 PMCID: PMC8266648 DOI: 10.1093/schbul/sbaa198] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Two previous randomized controlled trials (RCTs) suggested that adjunctive aspirin is efficacious in treating schizophrenia. We conducted two 16-week double-blind randomized placebo-controlled RCTs of adjunctive 1000 mg aspirin vs placebo in schizophrenia. Study 1 included 200 patients, with Positive and Negative Syndrome Scale (PANSS) total score as the primary outcome. Study 2 included 160 patients with C-reactive protein (CRP) >1 mg/L at baseline; the primary outcome was PANSS-positive score. Dropout rates for aspirin/placebo were 12% in study 1 and 20% in study 2. Differences in outcome between aspirin and placebo were calculated with linear regression, adjusting for the baseline value of the outcome. No statistically significant between-group differences were found in primary or secondary outcomes in either study. Study 1: mean difference in PANSS at 16 weeks was -3.9 (95% CI: -8.4 to 0.5, P = .10, effect size (ES) = -0.25) and at 8 weeks was -3.5 (95% CI: -7.5 to 0.5, P = .11, ES = -0.22). Study 2: mean difference in PANSS at 16 weeks was 0.3 (95% CI: -4.1 to 4.7, P = .90, ES = 0.02) and in positive PANSS was 0.5 (95% CI: -1.0 to 2.1, P = .50, ES = 0.11). A meta-analysis of these data with the existing studies, excluding one with large baseline differences in total PANSS, found that the overall estimate of the effect of adjunctive aspirin on the PANSS total score comparing group means at the end of the study was -2.9 (95% CI: -6.6 to 0.7; P = .21), favoring aspirin. Our studies and meta-analysis failed to find a statistically significant improvement in the symptoms of schizophrenia from adjunctive aspirin therapy in comparison to placebo in schizophrenia. Trial registration: study 1: Clinicaltrials.gov: NCT01320982; study 2 (high CRP): EudraCT Number: 2014-000757-36.
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Affiliation(s)
- Mark Weiser
- Department of Psychiatry, Sheba Medical Center, Tel Hashomer, Israel,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel,To whom correspondence should be addressed; Department of Psychiatry, Sheba Medical Center, Tel Hashomer, 52621, Israel; tel: +97235303773; +97235303773; fax: +97235353807; e-mail:
| | - Daisy Zamora
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC
| | - Linda Levi
- Department of Psychiatry, Sheba Medical Center, Tel Hashomer, Israel
| | - Igor Nastas
- Department of Psychiatry, Narcology and Medical Psychology, State University of Medicine and Pharmacy Nicolae Testemitanu, Chisinau, Moldova
| | | | | | - Valentin Matei
- Department of Psychiatry, Obrejia Hospital, Bucharest, Romania
| | - Anatol Nacu
- Department of Psychiatry, Narcology and Medical Psychology, State University of Medicine and Pharmacy Nicolae Testemitanu, Chisinau, Moldova
| | - Larisa Boronin
- Department of Psychiatry, Narcology and Medical Psychology, State University of Medicine and Pharmacy Nicolae Testemitanu, Chisinau, Moldova
| | | | - John M Davis
- Department of Psychiatry, University of Illinois, Chicago, IL
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Abdala R, Levi L, Longobardi V, Zanchetta MB. Severe bone microarchitecture deterioration in a family with hereditary neuropathy: evidence of the key role of the mechanostat. Osteoporos Int 2020; 31:2477-2480. [PMID: 33047192 DOI: 10.1007/s00198-020-05674-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 10/06/2020] [Indexed: 11/25/2022]
Abstract
In this report, we present three cases of individuals from the same family with a diagnosis of CMT with severe tibia bone microarchitecture deterioration assessed by HR-pQCT. Charcot-Marie-Tooth disease (CMT) or hereditary neuropathy involves both motor and sensory nerves. Falls are often the first manifestation in these patients and represent an important risk factor for fracture. The reduction of mechanical input on bone inhibits bone formation by osteoblasts and accelerates bone resorption by osteoclasts, leading to disuse osteoporosis. We report three cases of individuals from the same family with a diagnosis of CMT with severe tibia bone microarchitecture deterioration assessed by high-resolution peripheral quantitative computed tomography (HR-pQCT). This affectation was exclusive to the tibia; the radius remained undamaged, showing the consequences of the lack of mobility and mechanical stimulation. Physical activity and rehabilitation, in addition to adequate calcium and vitamin D supplementation, may play an essential role in the management of this disease.
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Affiliation(s)
- R Abdala
- IDIM, Libertad 836, 1st Floor, Zip code 1012, Buenos Aires, Argentina.
- Cátedra de Osteología y Metabolismo Mineral, Universidad del Salvador, Buenos Aires, Argentina.
| | - L Levi
- IDIM, Libertad 836, 1st Floor, Zip code 1012, Buenos Aires, Argentina
| | - V Longobardi
- IDIM, Libertad 836, 1st Floor, Zip code 1012, Buenos Aires, Argentina
- Cátedra de Osteología y Metabolismo Mineral, Universidad del Salvador, Buenos Aires, Argentina
| | - M B Zanchetta
- IDIM, Libertad 836, 1st Floor, Zip code 1012, Buenos Aires, Argentina
- Cátedra de Osteología y Metabolismo Mineral, Universidad del Salvador, Buenos Aires, Argentina
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Abstract
Abstract
One previous small single-center clinical trial showed that a single intravenous administration of sodium nitroprusside added-on to antipsychotics improved a wide spectrum of schizophrenia (SCZ) symptoms more than placebo, and the improvement persisted for 4 weeks after infusion even though no additional drug was given. Our study attempted to replicate these data in a 4-week, add-on, double-blind, randomized, placebo-controlled trial on 20 patients performed in a site in Romania and a site in Moldova. This study’s sample size and protocol were identical to the previous trial, including patients with a diagnosis of SCZ, within the first 5 years after diagnosis. Patients recruited needed to have a baseline total positive and negative syndrome scale (PANSS) score of 60 or above. Ten participants received a single dose of 0.5 µg/kg/min intravenous sodium nitroprusside over 4 hours, and 10 participants received matching placebo infusion, added-on to antipsychotics. The primary outcomes were the PANSS total score and the PANSS negative subscale. There were no significant between-group differences in PANSS total scores or negative subscale scores during the infusion on daily evaluations for the next 7 days nor on weekly evaluations at weeks 2, 3, and 4. No significant differences were found between the 2 study groups in adverse events. Meta-analyses including all 5 published randomized controlled trials on the topic, representing 155 subjects, do not show a statistically significant benefit of sodium nitroprusside. We conclude that the current evidence does not support the efficacy of sodium nitroprusside in the treatment of SCZ.
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Affiliation(s)
- Mark Weiser
- Department of Psychiatry, Sheba Medical Center, Ramat Gan, Israel
- Stanley Medical Research Institute, Kensington, MD
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daisy Zamora
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC
| | - Linda Levi
- Department of Psychiatry, Sheba Medical Center, Ramat Gan, Israel
| | - Valentin Matei
- Department of Psychiatry, Obrejia Hospital, Bucharest, Romania
| | | | | | - Michael Davidson
- Department of psychiatry, University of Nicosia Medical School, Nicosia, Cyprus
| | - John M Davis
- Department of Psychiatry, University of Illinois, Chicago, IL
- Department of Psychiatry, Johns Hopkins University Baltimore, MD
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Fuchs E, Levi L, Huszti EE, Picard BR, Berra G, Kawashima M, Takahagi A, Ghany R, Keshavjee S, Singer L, Tikkanen J, Martinu T. Significance of Phenotype Change Post CLAD-Onset on Allograft Survival. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Levi L, Bar Haim M, Burshtein S, Winter-Van Rossum I, Heres S, Davidson M, Shenkman G, Kahn RS, Weiser M. Duration of untreated psychosis and response to treatment: an analysis of response in the OPTiMiSE cohort. Eur Neuropsychopharmacol 2020; 32:131-135. [PMID: 32037127 DOI: 10.1016/j.euroneuro.2020.01.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/24/2019] [Accepted: 01/12/2020] [Indexed: 01/19/2023]
Abstract
Some, but not all, studies have found longer duration of untreated psychosis (DUP) to be associated with poor response to treatment and more severe negative symptoms in schizophrenia. The aim of the current analysis was to investigate these parameters in a large cohort of patients in their first psychotic episode. The OPTiMiSE cohort included 446 patients with DUP up to two years, who were administered amisulpride for 4 weeks (Phase I). Patients who did not meet Andreasen remission criteria were randomized to double-blind continuation of amisulpride or olanzapine for 6 additional weeks in a blinded study (Phase II). Analyses showed that shorter DUP was associated with lower baseline CGI scores (p<0.001, r = 0.184), PANSS total (p = 0.025, r = 0.106) and PANSS negative subscale scores (p = 0.023, r = 0.107). Remitters had a significantly shorter mean DUP compared to non-remitters both in Phase I (24.5 weeks ±24.3 vs. 35 weeks ± 32.2, p = 0.01, t=-2.521) and in Phase II (24.3 weeks ± 26.4 vs. 38.3 weeks ± 31.3, p = 0.031, t=-2.194). Logistic regression analyses showed a significant effect of DUP on treatment response both in phase I (p = 0.008) and phase II (p = 0.041). Linear regression analyses found that DUP significantly affects PANSS Total change at the end of phase I (p = 0.028) but not at the end of phase II (p = 0.236). Based on these findings, it is possible to conclude that shorter DUP is associated with better response to treatment, particularly during the first weeks after treatment initiation. These findings highlight the need for early identification of the first psychotic episode.
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Affiliation(s)
- Linda Levi
- Psychiatry Department, Sheba Medical Center, Tel-Hashomer, 52621 Ramat Gan, Israel
| | - Mor Bar Haim
- Psychiatry Department, Sheba Medical Center, Tel-Hashomer, 52621 Ramat Gan, Israel
| | - Shimon Burshtein
- Psychiatry Department, Sheba Medical Center, Tel-Hashomer, 52621 Ramat Gan, Israel
| | - Inge Winter-Van Rossum
- Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
| | - Stephan Heres
- Psychiatry Department, Technical University of Munich, Munich, Germany
| | - Michael Davidson
- Psychiatry Department, Sheba Medical Center, Tel-Hashomer, 52621 Ramat Gan, Israel; Nicosia School of Medicine, Cyprus
| | - Geva Shenkman
- Psychology Department, Interdisciplinary Center Hertzelya, Hertzelya, Israel
| | - René S Kahn
- Department of Psychiatry, Icahn School of Medicine, Mount Sinai, New York, USA
| | - Mark Weiser
- Psychiatry Department, Sheba Medical Center, Tel-Hashomer, 52621 Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Weiser M, Levi L, Zamora D, Biegon A, SanGiovanni JP, Davidson M, Burshtein S, Gonen I, Radu P, Slobozean Pavalache K, Nastas I, Hemi R, Ryan T, Davis JM. Effect of Adjunctive Estradiol on Schizophrenia Among Women of Childbearing Age: A Randomized Clinical Trial. JAMA Psychiatry 2019; 76:1009-1017. [PMID: 31365044 PMCID: PMC6669788 DOI: 10.1001/jamapsychiatry.2019.1842] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
IMPORTANCE Several lines of evidence suggest that estradiol influences the course of schizophrenia, and a previous randomized controlled trial demonstrated that transdermal estradiol improved symptoms in female patients of childbearing age. However, many initial positive findings in schizophrenia research are not later replicated. OBJECTIVE To independently replicate the results of the effect of estradiol on schizophrenia in women of childbearing age. DESIGN, SETTING, AND PARTICIPANTS An 8-week randomized, placebo-controlled trial performed in the Republic of Moldova between December 4, 2015, and July 29, 2016, among 200 premenopausal women aged 19 to 46 years with schizophrenia or schizoaffective disorder as defined by the DSM-5. INTERVENTION Patients were randomized to receive a 200-μg estradiol patch or placebo patch changed twice a week added to their antipsychotic treatment. MAIN OUTCOMES AND MEASURES The primary outcome was the positive subscale of the Positive and Negative Syndrome Scale (PANSS; lower scores indicated fewer symptoms and higher scores indicated more symptoms), analyzed with mixed models for repeated measures on an intention-to-treat basis. RESULTS A total of 100 women (median age, 38 years; interquartile range, 34-42 years) were randomized to receive an estradiol patch and 100 women (median age, 38 years; interquartile range, 31-41 years) were randomized to receive a placebo patch; the median age at baseline for the entire group of 200 women was 38.0 years (range, 19.5-46.0 years). At baseline, the mean positive PANSS score was 19.6 for both groups combined; at week 8, the mean positive PANSS score was 14.4 in the placebo group and 13.4 in the estradiol group. Compared with placebo, participants receiving add-on estradiol patches had statistically significant improvements in the primary outcome measure, PANSS positive subscale points (-0.94; 95% CI, -1.64 to -0.24; P = .008; effect size = 0.38). Post hoc heterogeneity analyses found that this effect occurred almost entirely in 100 participants older than 38.0 years (46 in placebo group vs 54 in estradiol group; difference, -1.98 points on the PANSS positive subscale; 95% CI, -2.94 to -1.02; P < .001). Younger participants did not benefit from estradiol (difference, 0.08 points on the PANSS positive subscale; 95% CI, -0.91 to 1.07; P = .87). Breast tenderness was more common in the estradiol group (n = 15) than in the placebo group (n = 1) as was weight gain (14 in estradiol group vs 1 in placebo group). CONCLUSIONS AND RELEVANCE The results independently replicate the finding that transdermal estradiol is an effective add-on treatment for women of childbearing age with schizophrenia and extend it, finding improvements in negative symptoms and finding that the effect could be specific to those older than 38 years. The results should be viewed in the context of the differences in the natural course of schizophrenia between females and males. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03848234.
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Affiliation(s)
- Mark Weiser
- Stanley Medical Research Institute, Kensington, Maryland,Department of Psychiatry, Sheba Medical Center, Tel Hashomer, Israel,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Linda Levi
- Department of Psychiatry, Sheba Medical Center, Tel Hashomer, Israel
| | - Daisy Zamora
- Department of Psychiatry, University of North Carolina, Chapel Hill,Laboratory of Clinical Investigation, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Anat Biegon
- Department of Radiology, Stony Brook University Medical School, Stony Brook, New York,Department of Neurology, Stony Brook University Medical School, Stony Brook, New York
| | - John Paul SanGiovanni
- Section on Nutritional Neuroscience, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland,Department of Biochemistry and Molecular & Cellular Biology, Georgetown School of Medicine, Washington, DC
| | - Michael Davidson
- Department of Psychiatry, Sheba Medical Center, Tel Hashomer, Israel,University of Nicosia Medical School, Engomi, Cyprus
| | - Shimon Burshtein
- Department of Psychiatry, Sheba Medical Center, Tel Hashomer, Israel
| | | | | | | | - Igor Nastas
- Psychiatry, Narcology, and Medical Psychology, State University of Medicine and Pharmaceuticals, “Nicolae Testemianu,” Chisinau, Moldova
| | - Rina Hemi
- Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, Israel
| | - Timothy Ryan
- Department of Psychiatry, University of Illinois, Chicago
| | - John M. Davis
- Department of Psychiatry, University of Illinois, Chicago,Department of Psychiatry, Johns Hopkins University, Baltimore, Maryland
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Weiser M, Levi L, Burshtein S, Chiriță R, Cirjaliu D, Gonen I, Yolken R, Davidson M, Zamora D, Davis JM. The effect of minocycline on symptoms in schizophrenia: Results from a randomized controlled trial. Schizophr Res 2019; 206:325-332. [PMID: 30455075 DOI: 10.1016/j.schres.2018.10.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 10/22/2018] [Accepted: 10/23/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Studies have hypothesized that immunological abnormalities might contribute to schizophrenia, and basic science studies, as well as several clinical trials suggest that minocycline could be efficacious in ameliorating both positive and negative symptoms of schizophrenia. In this study we examined the effect of minocycline on schizophrenia in a large randomized controlled trial. METHODS We performed a 16-week, multi-center, double-blind, randomized, placebo-controlled study on 200 subjects with schizophrenia or schizoaffective disorder randomized to receive either minocycline (200 mg/day, n = 100), or placebo (n = 100) as an add-on to anti-psychotic treatment. The primary outcome measure was the PANSS total score. RESULTS Mixed models for repeated measures showed no significant difference between minocycline and placebo for total PANSS (p = 0.862), PANSS subscales, CGI or BACS. CONCLUSIONS Minocycline did not improve symptoms or cognition in schizophrenia.
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Affiliation(s)
- Mark Weiser
- Department of Psychiatry, Sheba Medical Center, Tel Hashomer 52621, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Linda Levi
- Department of Psychiatry, Sheba Medical Center, Tel Hashomer 52621, Israel
| | - Shimon Burshtein
- Department of Psychiatry, Sheba Medical Center, Tel Hashomer 52621, Israel
| | - Roxana Chiriță
- Spitalul Clinic de Psihiatrie Socola, Iași. Șos. Bucium 36, Iași, Romania
| | - Diana Cirjaliu
- Clinica de Psihiatrie Palazu Mare, Constanta, Tomis 145, Constanța, Romania
| | | | - Robert Yolken
- Dept. of Pediatrics, John's Hopkins School of Medicine, Baltimore, MD, USA
| | - Michael Davidson
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; University of Nicosia Medical School, Cyprus
| | - Daisy Zamora
- Dept. of Psychiatry, University of North Carolina, Chappel Hill, NC, USA
| | - John M Davis
- Department of Psychiatry, University of Illinois, Chicago, IL 60607, USA
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Amiaz R, Asher E, Rozen G, Czerniak E, Levi L, Weiser M, Glikson M. Reduction in depressive symptoms in primary prevention ICD scheduled patients - One year prospective study. Gen Hosp Psychiatry 2017; 48:37-41. [PMID: 28917393 DOI: 10.1016/j.genhosppsych.2017.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 05/16/2017] [Accepted: 06/29/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Implantable Cardioverter Defibrillators (ICDs), have previously been associated with the onset of depression and anxiety. The aim of this one-year prospective study was to evaluate the rate of new onset psychopathological symptoms after elective ICD implantation. METHODS A total of 158 consecutive outpatients who were scheduled for an elective ICD implantation were diagnosed and screened based on the Mini International Neuropsychiatric Interview (MINI). Depression and anxiety were evaluated using the Hamilton Rating Scales for Depression (HAM-D) and Anxiety (HAM-A). Patient's attitude toward the ICD device was evaluated using a Visual Analog Scale (VAS). RESULTS Patients' mean age was 64±12.4years; 134 (85%) were men, with the majority of patients performing the procedure for reasons of 'primary prevention'. According to the MINI diagnosis at baseline, three (2%) patients suffered from major depressive disorder and ten (6%) from dysthymia. Significant improvement in HAM-D mean scores was found between baseline, three months and one year after implantation (6.50±6.4; 4.10±5.3 and 2.7±4.6, respectively F(2100)=16.42; p<0.001). There was a significantly more positive attitude toward the device over time based on the VAS score [F(2122)=53.31, p<0.001]. CONCLUSIONS ICD implantation significantly contributes to the reduction of depressive symptoms, while the overall mindset toward the ICD device was positive and improved during the one-year follow-up.
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Affiliation(s)
- Revital Amiaz
- Psychiatry Department, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Elad Asher
- Davidai Arrhythmia Center, Leviev Heart Center, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy Rozen
- Davidai Arrhythmia Center, Leviev Heart Center, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Efrat Czerniak
- Psychiatry Department, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Linda Levi
- Psychiatry Department, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Mark Weiser
- Psychiatry Department, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Glikson
- Davidai Arrhythmia Center, Leviev Heart Center, The Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Weiser M, Levi L, Burshtein S, Hagin M, Matei VP, Podea D, Micluția I, Tiugan A, Păcală B, Grecu IG, Noy A, Zamora D, Davis JM. Raloxifene Plus Antipsychotics Versus Placebo Plus Antipsychotics in Severely Ill Decompensated Postmenopausal Women With Schizophrenia or Schizoaffective Disorder: A Randomized Controlled Trial. J Clin Psychiatry 2017; 78:e758-e765. [PMID: 28541645 DOI: 10.4088/jcp.15m10498] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 09/19/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Several single-center studies have found raloxifene, an estrogen agonist, to be effective in ameliorating symptoms of schizophrenia in stable patients as augmentation of antipsychotics. This multicenter study assessed whether raloxifene plus antipsychotic treatment, in comparison to placebo plus antipsychotics, improves symptoms or cognition in severely ill decompensated schizophrenia patients. METHODS In this 16-week, double-blind, randomized, placebo-controlled study, 200 severely ill, decompensated postmenopausal women who met DSM-IV-TR criteria for schizophrenia or schizoaffective disorder were recruited from January 2011 to December 2012 and were randomized to receive either raloxifene 120 mg/d plus antipsychotics or placebo plus antipsychotics. The primary outcome measure was Positive and Negative Syndrome Scale (PANSS) total score at the end of the trial. RESULTS The placebo plus antipsychotics group experienced statistically significant improvement in PANSS total score (P < .001) compared to the raloxifene plus antipsychotics group, using mixed models for repeated measures, with results favoring placebo by 4.5 points (95% CI, 2.3-6.7). These results were clearly outside the 95% confidence interval. This negative effect was more pronounced in patients who had more frequent relapses and in those with baseline PANSS scores of 100 or higher. There were no differences between groups in Clinical Global Impression Scale-Severity scores or Composite Brief Assessment of Cognition in Schizophrenia scores at 16 weeks (P > .3). Baseline follicle-stimulating hormone and estradiol levels did not alter the drug-placebo differences. CONCLUSIONS Individuals in the active treatment arm showed worse outcome than those in the placebo arm, most likely as a result of chance variation, but the results unequivocally show no benefit of antipsychotics plus raloxifene versus antipsychotics plus placebo in this large randomized, double-blind, placebo-controlled trial in postmenopausal women. These data do not support the use of raloxifene in severely decompensated schizophrenia patients until reliable research identifies what subgroup of patients or domain of outcome is benefited. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01280305.
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Affiliation(s)
- Mark Weiser
- Department of Psychiatry, Chaim Sheba Medical Center, Tel-Hashomer, 52621, Israel. .,Division of Psychiatry, Chaim Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Linda Levi
- Division of Psychiatry, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Shimon Burshtein
- Division of Psychiatry, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Michal Hagin
- Division of Psychiatry, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | | | | | - Ioana Micluția
- Spitalul Clinic Judetean, Sectia Clinica Psihiatrie II, Cluj, Romania
| | - Alexandru Tiugan
- Spitalul Clinic de Urgenta Militar "Dr. Stefan Odobleja," Craiova, Romania
| | - Bogdan Păcală
- Spitalul Clinic de Psihiatrie "Dr. Gheorghe Preda," Sibiu, Romania
| | - Iosif Gabos Grecu
- Spitalul Clinic Judetean Mures, Sectia Clinica Psihiatrie I, Târgu Mureș, Romania
| | - Adam Noy
- St George's, University of London, London, England
| | - Daisy Zamora
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA
| | - John M Davis
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois, USA
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Miron-Shatz T, Rapaport SR, Srebnik N, Hanoch Y, Rabinowitz J, Doniger GM, Levi L, Rolison JJ, Tsafrir A. Invasive Prenatal Diagnostic Testing Recommendations are Influenced by Maternal Age, Statistical Misconception and Perceived Liability. J Genet Couns 2017; 27:59-68. [DOI: 10.1007/s10897-017-0120-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 05/30/2017] [Indexed: 10/19/2022]
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Weiser M, Levi L, Levine SZ, Bialer M, Shekh-Ahmad T, Matei V, Tiugan A, Cirjaliu D, Sava C, Sinita E, Zamora D, Davis JM. A randomized, double-blind, placebo- and risperidone-controlled study on valnoctamide for acute mania. Bipolar Disord 2017; 19:285-294. [PMID: 28605109 DOI: 10.1111/bdi.12506] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 04/03/2017] [Accepted: 04/16/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Mood stabilizers administered for bipolar disorder during pregnancy, such as valproic acid, can increase the risk of congenital anomalies in offspring. Valnoctamide is a valproic acid derivative associated with a decreased risk for congenital abnormalities in animals. The present study evaluated the efficacy and safety of valnoctamide monotherapy, compared to placebo, in the treatment of patients in an acute manic episode. METHODS A 3-week, double-blind, randomized, placebo- and risperidone-controlled, parallel group trial was conducted on 173 patients in an acute manic episode. Patients were randomized to receive valnoctamide 1500 mg/d (n=71), risperidone 6 mg/d (n=32), or matching placebo (n=70). The primary outcome measure was the change in Young Mania Rating Scale (YMRS) scores. RESULTS Valnoctamide did not differ significantly from placebo on any of the study endpoints (YMRS, Positive and Negative Syndrome Scale, and the Clinical Global Impression Scale for Bipolar Disorder [CGI-BP] scales; all P>.60). Mixed models for repeated measures showed that risperidone produced significantly more improvement than placebo in the overall bipolar disorder CGI-BP severity scale (P=.036), and the CGI-BP severity scale for mania (P=.021). The Kaplan-Meier survival curve revealed higher all-cause discontinuation rates (mainly due to lack of efficacy) in the valnoctamide group compared to the other study groups (P=.026). Patients with higher valnoctamide plasma levels had a numerically higher YMRS response, but this was not statistically significant. CONCLUSIONS Valnoctamide was well tolerated at 1500 mg/d but lacked efficacy in the treatment of symptoms in patients with acute mania. Possible differences between the biological mechanisms of action of valproic acid and valnoctamide are discussed.
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Affiliation(s)
- Mark Weiser
- Division of Psychiatry, Chaim Sheba Medical Center, Tel HaShomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Linda Levi
- Division of Psychiatry, Chaim Sheba Medical Center, Tel HaShomer, Israel
| | - Stephen Z Levine
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Meir Bialer
- School of Pharmacy, Institute for Drug Research, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Tawfeeq Shekh-Ahmad
- School of Pharmacy, Institute for Drug Research, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Valentin Matei
- Spitalul Clinic de Psihiatrie Obregia, Bucarest, Romania
| | - Alexandru Tiugan
- Sp. Clinic de Urgenta Militar "Dr. Stefan Odoblegea", Craiova, Romania
| | - Diana Cirjaliu
- Spitalul Judetean Constanta, Clinica de Psihiatrie Palazu Mare, Costanta, Romania
| | - Cristinel Sava
- Spitalul Judetean de Urgente, Piatra Neamt, Neamt, Romania
| | - Eugenia Sinita
- Spitalul Clinic de Psihiatrie Chisinau, Republica Moldova, Chisinau, Moldova
| | - Daisy Zamora
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - John M Davis
- Department of Psychiatry, University of Illinois, Chicago, IL, USA
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Levi L, Werbeloff N, Pugachova I, Yoffe R, Large M, Davidson M, Weiser M. Has deinstitutionalization affected inpatient suicide? Psychiatric inpatient suicide rates between 1990 and 2013 in Israel. Schizophr Res 2016; 173:75-8. [PMID: 26965744 DOI: 10.1016/j.schres.2016.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 03/01/2016] [Accepted: 03/04/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To examine variations in rates of inpatient suicide and clinical risk factors for this phenomenon. METHOD The National Israeli Psychiatric Hospitalization Case Registry was used to study inpatient suicide. Clinical risk factors for inpatient suicide were examined in a nested case control design. RESULTS Between 1990 and 2013 there were 326 inpatient suicides, at an average of one inpatient suicide per 1614 admissions. A significant decline in rates of suicide per admission over time (p<0.001) was associated with a reduced number of beds (p<0.001) and a decline in nationwide suicide rates (p=0.001). Clinical risk factors for inpatient suicide were: affective disorders (OR=5.95), schizoaffective disorder (OR=5.27), schizophrenia (OR=3.82), previous suicide attempts (OR=2.59), involuntary hospitalization (OR=1.67), and more previous hospitalizations (OR=1.16,). A multivariate model with sensitivity of 27.3% and specificity of 95.3% for inpatient suicide, showed a positive predictive value of 0.4%. CONCLUSIONS The absolute number and rates of inpatient suicide per admission have decreased over time, probably due to the decreased number of beds lowering total time at risk. Patients with affective and psychotic disorders and with previous suicide attempts have the greatest risk of inpatient suicide. However, clinical characteristics do not enable identification of patients who are at risk for suicide.
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Affiliation(s)
- Linda Levi
- Department of Psychiatry, Sheba Medical Center, Tel Hashomer, Israel.
| | - Nomi Werbeloff
- Division of Psychiatry, University College London, England, United Kingdom
| | | | | | | | - Michael Davidson
- Department of Psychiatry, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mark Weiser
- Department of Psychiatry, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Lifshitz Y, Levi L, Eyal I, Cohen T, Tessler S. Sub-chronic (13-week) oral toxicity study, preceded by an in utero exposure phase and genotoxicity studies with fish source phosphatidylserine in rats. Food Chem Toxicol 2015; 86:234-44. [PMID: 26498410 DOI: 10.1016/j.fct.2015.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 09/21/2015] [Accepted: 10/15/2015] [Indexed: 11/17/2022]
Abstract
The safety of fish phosphatidylserine (PS) conjugated to DHA (InCog™) was examined in a series of toxicology studies as first step to support future use in infants and general population using in vitro genotoxicity tests and in a sub-chronic toxicity study with an in-utero exposure phase. PS is a major lipid in the cell membrane, active in various membrane-mediated processes. PS-DHA, present in human milk, has been suggested to be important for early brain development. Rats were exposed to diets containing 1.5%, 3% or 4.5% InCog or two control diets. Parental (F0) animals were fed throughout mating, gestation and lactation. Subsequently, a subchronic, 13-week study was conducted on the F1 animals followed by 4 weeks of recovery. The genotoxicity tests showed no mutagenicity potential. No significant toxicological findings were found in the F0 rats or the F1 pups. In the 13-weeks study, an increase in the presence of renal minimal-mild multifocal corticomedullary mineralization was noted in nine females of the high-dose group. This change was not associated with any inflammatory or degenerative changes in the kidneys. The no-observed-adverse-effect level (NOAEL) in the present study was placed at 3% in the diet (mid-dose group), equivalent to an overall intake of at least 2.1 g InCog/kg bw/day in the F1 generation.
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Affiliation(s)
- Y Lifshitz
- Nutrition R&D, Enzymotec, Migdal HaEmeq, Israel.
| | - L Levi
- Nutrition R&D, Enzymotec, Migdal HaEmeq, Israel
| | - I Eyal
- Nutrition R&D, Enzymotec, Migdal HaEmeq, Israel
| | - T Cohen
- Nutrition R&D, Enzymotec, Migdal HaEmeq, Israel
| | - S Tessler
- Nutrition R&D, Enzymotec, Migdal HaEmeq, Israel
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Levi L. Emotional stress and sympatho-adrenomedullary and related physiological reactions with particular reference to cardiovascular pathology. Bibl Psychiatr 2015; 144:38-51. [PMID: 5499614 DOI: 10.1159/000385837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Smolin B, Levy Y, Sabbach-Cohen E, Levi L, Mashiach T. Predicting mortality of elderly patients acutely admitted to the Department of Internal Medicine. Int J Clin Pract 2015; 69:501-8. [PMID: 25311361 DOI: 10.1111/ijcp.12564] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 09/01/2014] [Indexed: 11/28/2022] Open
Abstract
AIMS This study addresses the common practice of providing aggressive treatments of limited clinical benefit and cost-effectiveness to seriously ill and frail elderly. We have created a statistical model of 6-month mortality risk prediction following acute hospitalisation admission, and identified a subset of patients with poorest prognosis that requires comfort-focused care. METHODS We have studied electronic medical records of 26,937 patients age 65 years or older, hospitalised in the internal medicine departments of one tertiary-care teaching medical center in Northern Israel from January 1, 2008 through December 31, 2011 and mortality data from the Israeli Internal Ministry Registry. Norton score records were employed for the performance status evaluation. Multivariate logistic regression analysis was used to predict the risk of 6-month mortality. RESULTS Variables associated with an increased risk of 6-month mortality included: metastatic cancer, age above 85 years, decreased values of blood albumin and haemoglobin, increased blood urea nitrogen and decreased physical/mental status and activity. The receiver operating characteristic area for the predicted probability of death was 0.845 and 0.847 in external validation cohort. Using predictive values of the logistic regression analysis, the study cohort was stratified into six groups with various predictive mortality risks. CONCLUSION The majority of deaths that have occurred within 6 months following the acute hospitalisation could be predicted on patient admission based on a few simple and easily obtained parameters. Earlier recognition of patients nearing the end of their lives may lead to better care and more efficient use of available resource.
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Affiliation(s)
- B Smolin
- Department of Internal Medicince D, Technion Faculty of Medicine, Rambam Health Care Campus, Haifa, Israel
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Abstract
The effect of a 75-hour vigil on the erythrocyte sedimentation rate (ESR), i.a., was studied in two experiments with 63 healthy male volunteers. The ESR was increased at the end of the vigil compared with pre-exposure values. The increases did not correlate significantly with concomitant changes in serum triglycerides, free fatty acids, cholesterol or gammaglobulins, except for a significant, negative correlation with cholesterol changes in one of the two studies. Although the mechanism for the increases in ESR in response to stressor exposure remains unclear, it is concluded that when using the ESR in clinical practice, allowance should be made for situational factors such as the patient having experienced some stressful days and sleepless nights.
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Zaaroor M, Soustiel JF, Brenner B, Bar-Lavie Y, Martinowitz U, Levi L. Administration off label of recombinant factor-VIIa (rFVIIa) to patients with blunt or penetrating brain injury without coagulopathy. Acta Neurochir (Wien) 2008; 150:663-8. [PMID: 18473114 DOI: 10.1007/s00701-008-1593-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2007] [Accepted: 03/26/2008] [Indexed: 11/28/2022]
Abstract
Traumatic brain contusions may increase in size over time or may develop at a delay after injury. This may lead to neurological deterioration, long term morbidity or even death. Coagulation disorders after injury can contribute to progression of haemorrhage. Recombinant activated factor VII (rFVIIa) was used in 12 patients with a severe head injury who had no systemic coagulopathy but who were considered to be at risk of progression of their intracranial lesion. Twelve consecutive patients suffering from life-threatening acute head injuries from blunt (3 cases) and penetrating mechanisms were given with rFVIIa, either to prevent the expected development of brain contusion or to assist in bleeding control during surgery. In 11 patients, rFVIIa was given by the attending neurosurgeon. Two of the patients died of their severe penetrating injuries one of whom had severe vasospasm 2 days after administration of rFVIIa. The other 11 patients did not appear to suffer any treatment-related adverse effects. When the drug was given prophylactically to prevent brain resection (6 cases) or to limit the need for widening resection (5 cases), marked control was achieved in seven cases, and a lesser effect was observed in the other 4 cases. We conclude that, in a small and highly individually selected series of patients with severe head injury, the administration of rFVIIa did not lead to adverse effects. Although the majority of patients were considered to be at high risk of progression of their lesions, this occurred in only one. The early use of rFVIIa in head injured patients without systemic coagulopathy may reduce the occurrence of enlargement of contusions, the requirement of further operation, and adverse outcome. Prospective randomised controlled studies are required to investigate this.
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Affiliation(s)
- M Zaaroor
- Department of Neurosurgery, Rambam Medical Centre and B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Mnatzaganian G, Galai N, Sprung CL, Zitser-Gurevich Y, Mandel M, Ben-Hur D, Gurman G, Klein M, Lev A, Levi L, Bar-Lavi Y, Zveibil F, Simchen E. Increased risk of bloodstream and urinary infections in intensive care unit (ICU) patients compared with patients fitting ICU admission criteria treated in regular wards. J Hosp Infect 2005; 59:331-42. [PMID: 15749322 DOI: 10.1016/j.jhin.2004.07.028] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2004] [Accepted: 07/26/2004] [Indexed: 01/11/2023]
Abstract
Critically ill patients, eligible for admission into intensive care units (ICUs), are often hospitalized in other wards due to a lack of ICU beds. Differences in morbidity between patients managed in ICUs and elsewhere are unknown, specifically the morbidity related to hospital-acquired infection. Patients fitting ICU admission criteria were identified by screening five entire hospitals on four separate days. Hospital infections within a 30-day follow-up period were compared in ICU patients and in patients on other wards using Kaplan-Meier curves. Residual differences in the patients' case mix between ICUs and other wards were adjusted for utilizing multivariate Cox models. Of 13415 patients screened, 668 were critically ill. The overall infection rates (per 100 patient-days) were 1.2 for bloodstream infection (BSI) and 1.9 for urinary tract infection (UTI). The adjusted hazard ratios in ICU patients compared with patients on regular wards were 3.1 (P<0.001) for BSI and 2.5 (P<0.001) for UTI. This increased risk persisted even after adjusting for the disparity in the number of cultures sent from ICUs compared with ordinary wards. No interdepartmental differences were found in the rates of pneumonia, surgical wound infections and other infections. Minimizing the differences between characteristics of patients hospitalized in ICUs and in other wards, and controlling for the higher frequency of cultures sent from ICUs did not eliminate the increased risk of BSI and UTI associated with admission into ICUs.
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Affiliation(s)
- G Mnatzaganian
- Department of Health Services Research, Ministry of Health, P.O. Box 1176, Jerusalem 91010, Israel
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Affiliation(s)
- Sharon Kelly West
- Transitions Health System, Inc., 35 Summerhill Drive, Asheville, NC 28804, USA.
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Abstract
Selecting the right accreditation organization is an important decision. This month's column reviews the three nationally recognized accreditation organizations, and examines their standards and survey activities. Factors home care organizations should consider when choosing an accreditation body are presented to facilitate knowledgeable decision making.
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Affiliation(s)
- Linda Levi
- Glory Health Systems, Weaverville, NC, USA.
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Abstract
The 2003 release of the Hospice Accreditation Manual is now available from the ACHC. This article examines changes made in the manual and survey process and highlights a few of the new standards found in the Hospice Interpretive Guide to Standards for Accreditation.
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Affiliation(s)
- Linda Levi
- Accreditation Commission for Health Care, Raliegh, NC 27612, USA.
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Wade NK, Levi L, Jones MR, Bhisitkul R, Fine L, Cunningham ET. Optic disk edema associated with peripapillary serous retinal detachment: an early sign of systemic Bartonella henselae infection. Am J Ophthalmol 2000; 130:327-34. [PMID: 11020412 DOI: 10.1016/s0002-9394(00)00599-7] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe optic disk edema associated with peripapillary serous retinal detachment as an early sign of systemic Bartonella henselae infection. METHODS Multicentered, retrospective case series. RESULTS Five women and two men presented with optic disk edema producing peripapillary serous retinal detachment. Each patient had a markedly elevated serum anti-B. henselae antibody titer. Patient age ranged from 11 to 44 years, with a mean and median of 26.6 and 28 years, respectively. The time from the onset of systemic symptoms to the onset of visual symptoms varied from 3 days to 1 month. The peripapillary serous retinal detachment resolved within 1 to 3 weeks in each case, producing a macular star in four of seven patients. Initial vision was 20/200 or worse in five of seven patients and improved in four of these five patients to 20/30 or better. CONCLUSIONS Systemic B. henselae infection should be considered in patients who develop optic disk edema associated with a peripapillary serous retinal detachment, even in the absence of classic neuroretinitis with a macular star.
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Affiliation(s)
- N K Wade
- Francis I. Proctor Foundation, University of California, San Francisco, CA 94143-0944, USA
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Ozerdem U, Levi L, Cheng L, Song MK, Scher C, Freeman WR. Systemic toxicity of topical and periocular corticosteroid therapy in an 11-year-old male with posterior uveitis. Am J Ophthalmol 2000; 130:240-1. [PMID: 11004305 DOI: 10.1016/s0002-9394(00)00501-8] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE To report a case of systemic corticosteroid toxicity resulting from topical and periocular therapy. METHODS Treatment and follow-up of an 11-year-old male with uveitis are illustrated. Initial presentation of the patient was bilateral iridocyclitis, for which he was treated with prednisolone acetate 1% every 2 hours for 6 months. Subsequently, posterior uveitis developed, necessitating posterior subtenon injections. RESULTS After initial topical corticosteroid therapy, the patient developed a cushingoid habitus accompanied by increased lanugo hair, acanthosis nigricans, posterior subcapsular lens opacities, and increased intraocular pressure. Cushingoid stigmata worsened after administration of posterior subtenon injection of corticosteroids. The patient's truncal obesity worsened, and his linear growth stopped. CONCLUSIONS Systemic toxic effects may develop as a result of topical and local use of ophthalmic corticosteroid preparations in susceptible patients.
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Affiliation(s)
- U Ozerdem
- Shiley Eye Center, University of California, San Diego, La Jolla, California 92093-0946, USA
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Levi L, Michaelson M. [Prioritizing suspected diagnosis of both brain and abdominal injuries--is it a problem?]. Harefuah 2000; 138:287-90, 343. [PMID: 10883113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Current guidelines for management of suspected head and abdominal injuries are based on retrospective studies like that of Wisner & al, Following a recent review in this journal by Y. Kluger & al, which was based on non-Israeli data, we decided to define the current status at our trauma center. We compare our data of 18 months of hospital admissions for acute trauma in which head CTs were done with those of 5 articles advocating specific protocols for decisions in pre-laparotomy diagnosis. In the 861 cumulated cases, compared with the 800 of Wisner & al, craniotomy was required in 15% vs 7% (p < 0.05); laparotomy was much less frequent, 2.7% vs 12.9% (p < 0.05). The chance of finding a case requiring both craniotomy and laparotomy was 1 in 300. As the clinical condition of multiple trauma involving the head and abdomen is becoming less frequent and includes diverse situations, a comprehensive algorithm might be inaccurate. Good clinical judgment of the clinician and teamwork are therefore preferable.
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Affiliation(s)
- L Levi
- Dept. of Neurosurgery and Trauma Unit, Rambam Medical Center, Haifa
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Levi L, Knoller N. [Developing clinical guidelines for management of severe head injuries]. Harefuah 2000; 138:148-53. [PMID: 10883080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Levi L, Bartley M, Marmot M, Karasek R, Theorell T, Siegrist J, Peter R, Belkić K, Savić C, Schnall P, Landsbergis P. Stressors at the workplace: theoretical models. Occup Med 2000; 15:69-106. [PMID: 10620787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
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Levi L, Fine L, Steenland K, Warren N, Shimomitsu T, Odagiri Y, Kimmel M, Landsbergis P. Legal and legislative issues. Occup Med 2000; 15:269-92. [PMID: 10702090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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Abstract
Many states and school districts, as well as Principles and Standards for School Mathematics: Discussion Draft (NCTM 1998), recommend that algebra be taught in the early childhood years. Although young children often understand much more than traditionally thought, adults can have difficulty conceptualizing what would constitute appropriate algebra for the early childhood years.
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Affiliation(s)
- Karen Falkner
- 1 Is a primary-grade teacher at Lapham Elementary School, Madison, WI 53703
| | - Linda Levi
- 2 Affiliated with the Wisconsin Center for Educational Research, Madison, WI 53706
| | - Thomas Carpenter
- 2 Affiliated with the Wisconsin Center for Educational Research, Madison, WI 53706
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Affiliation(s)
- L Levi
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden.
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Affiliation(s)
- L Levi
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden.
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Abstract
We evaluated nine patients with external ophthalmoparesis and increased intracranial pressure. The eye movements normalized when the intracranial pressure was controlled. Investigations for an underlying cause of elevated cerebrospinal fluid pressure are warranted when ocular motility disorders are present.
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Affiliation(s)
- D I Friedman
- Department of Neurology, SUNY Health Science Center, Syracuse, NY 13210, USA
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Bregman D, Levi L. [Use of Intranet in the hospital setting]. Harefuah 1998; 134:753-7, 832. [PMID: 10909629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
In the Intranet system, the organization uses technologies developed and applied in the Internet network world-wide. Hospitals can use Internet technologies to make hospital information systems more efficient by improving use of existing systems and by adding additional possibilities. Furthermore, the hospital can improve its relations with its customers and also bring the organization additional customers. Intranet implementation can be divided into the areas of: communication, managing and distributing information, and application linkage. Implementation must be modular, gradual and planned according to economic, technological and organizational aspects of the hospitals. By the Intranet, organizations can achieve benefits that include: improving communication array, availability of data and information, using existing information systems and their applications, enhancing customer satisfaction and saving costs of manual application systems.
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Levi L, Guilburd JN, Bar-Yosef G, Zaaroor M, Soustiel JF, Feinsod M. Severe head injury in children--analyzing the better outcome over a decade and the role of major improvements in intensive care. Childs Nerv Syst 1998; 14:195-202. [PMID: 9660122 DOI: 10.1007/s003810050210] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We suggest a few possible explanations, including improvement of intensive care, as the main cause, for the improved outcome after severe head injury in children and present the predictors of outcome observed in a contemporary series. From January 1984 to June 1988 we saw 117 children (ages 0-14) with postresuscitation GCS (Glasgow Come Scale) scores of 3-8. The more recent cohort of children seen in 1994-1996 was made up of 152 patients. Apart from standard statistics we used a segmentation method called CHAID (SSPS software). Previously known predictors of outcome are found still to apply in our series. Although in the recent period there was a lower proportion of patients with GCS 3-4 (11% versus 32%), a higher percentage had suffered multiple trauma (56% versus 33%). The rates of craniotomy and of ICP monitoring were similar (66% and 61%). Comparison of the two cohorts for outcome at discharge and through 1 year shows that mortality fell from 33% to 10% and the proportion achieving improvement of neurological status increased from 24% to 56%. CHAID analysis showed that the mortality rates of patients within specific groups declined significantly over the two periods: (1) a significant reduction in mortality was seen in patients with GCS 5-7, especially those with diffuse axonal injury (DAI) (17.3% to 0%); (2) no child admitted in shock survived in the earlier period, whereas 7 with GCS 4-6 survived during the recent period. The best model for mortality prediction includes GCS, and in the GCS 4-7 subgroup, the presence of subdural hematoma. It seems that the trend toward better immediate outcome is continuous, and this is the more striking when the severity of injury is taken into consideration. Our belief is that the modern medical and surgical techniques, although incurring higher costs and necessitating ongoing intensity, are well worth the effort.
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Affiliation(s)
- L Levi
- Department of Neurosurgery, Rambam Medical Center, Technion Faculty of Medicine, Haifa, Israel
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Knoller N, Levi L, Feibel M, Rapoport Z, Sagiv S, Kluger Y, Hadani M, Feinsod M. [An algorithm for clearance of the cervical spine in patients after trauma]. Harefuah 1998; 134:403-9. [PMID: 10909563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Levi L. Psychosocial environmental factors and psychosocially mediated effects of physical environmental factors. Scand J Work Environ Health 1998; 23 Suppl 3:47-52. [PMID: 9456066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The great difficulty with psychosocial environmental factors and psychosocially mediated effects of physical environmental factors is their great complexity. They finally produce stimuli that act on an organism. The organism is characterized by psychobiological programming determined by genetic factors and by earlier environmental influences. The interaction between these factors causes the organism to react. In some cases the reaction manifests itself as a disease, in some as a psychosomatic symptom. The task is to identify critically important system components that are necessary or sufficient or contributory in causing disease or accelerating its course or triggering its symptoms. It is not just causation in the strict sense of the word; a broader concept is needed to identify these components so that something can be done about them.
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Affiliation(s)
- L Levi
- Karolinska Institute, Department of Stress Research, Stockholm, Sweden
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Levi L, Bregman D, Geva H, Revach M. Hospital disaster management simulation system. Prehosp Disaster Med 1998; 13:29-34. [PMID: 10187023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
INTRODUCTION Theoretically, simulation of disastrous situations has many advantages in that it prepares hospital staff to cope with the real scenario. It is a challenge to create the database and custom-making a friendly software while still keeping it representative of a real situation. This article describes experience with developing and implementing the use of simulation software as a drilling technique used by Israeli hospitals. METHODS The application was developed using SIMAN/ARENA software. Knowledge and a database for a basic multi-casualty incident (MCI) were developed in the pilot phase. It contains detailed descriptions of the casualties which can be compared with the real hospital capabilities (staff and infrastructure). A consensus committee decided the crucial model issues and established the thresholds for quality performance indicators. Interfaces to the each hospital's information management systems (IMS) were developed and the various output documents of each exercised step were updated. Before drilling, the hospital managerial staff received notice and had to prepare the data on the anticipated resources required. The simulation staff, as well as representatives from the hospitals, then conducted the limited scale drill (LSD). RESULTS During the LSD, the trained hospital staff were given two types of input: 1) copies of reports on patients entering the stations and had to enter them into its IMS; and 2) timed telephone notifications of problems in each station. During a 90 minutes drill, there were about 15 timely reports and 20 telephone problems. The evaluation of the LSD were based mainly on the following: 1) observing the staff solving various problems; 2) constructing a detailed picture of the situation; and 3) measuring the effectiveness of the hospital IMS. The drill ended with a discussion. Lessons are drawn from each drill in order to find methods for optimizing the conduct of the hospital. An animation tool proved to be useful in describing bottle necks in emergency room, diagnostic department, and operating rooms. CONCLUSIONS Simulation techniques and a preparatory limited scale drill have advantages in evaluating and improving preparedness of hospitals for managing an MCI before a full scale drill is carried out.
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Affiliation(s)
- L Levi
- Trauma Research Unit, Rambam Medical Center, Haifa, Israel.
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Levi L. A biopsychosocial approach to etiology and pathogenesis. Acta Physiol Scand Suppl 1997; 640:103-6. [PMID: 9401618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The interactive etiological and pathogenic processes between physical and psychosocial environ-mental stimuli, the individual's appraisal of these influences, and his or her reactions to them in terms of emotion, cognition, behaviour, and physiology; the modification of these reactions through coping, social support, and other interacting variables; and the resulting changes in health and well-being--are extremely complex and poorly understood. Against this background, this paper argues for a biopsychosocial approach, based on an ecological model influenced by, and influencing, James P. Henry's related approaches. This approach is exemplified in six studies carried out by our group and briefly reviewed in this paper.
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Affiliation(s)
- L Levi
- Division of Psychosocial Factors and Health, Karolinska institutet, Stockholm, Sweden
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Gupta N, Kikkawa DO, Levi L, Weinreb RN. Severe vision loss and neovascular glaucoma complicating superior ophthalmic vein approach to carotid-cavernous sinus fistula. Am J Ophthalmol 1997; 124:853-5. [PMID: 9402840 DOI: 10.1016/s0002-9394(14)71711-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To report a patient with unilateral vision loss and neovascular glaucoma after attempted superior ophthalmic vein embolization in the treatment of a carotid-cavernous sinus fistula. METHODS A 69-year-old man with a history of a left dural carotid-cavernous sinus fistula underwent attempted treatment with superior ophthalmic vein embolization. The procedure was unsuccessful, and the left superior ophthalmic vein was ligated. RESULTS Uncontrolled left proptosis and intraocular pressure necessitated urgent orbital decompression with severe vision loss and neovascular glaucoma. CONCLUSION Superior ophthalmic vein embolization in the management of carotid-cavernous fistula may be associated with vision-threatening complications.
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Affiliation(s)
- N Gupta
- Department of Ophthalmology, University of California, San Diego 92093-0946, USA
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